Topics and signs: defensive control of emotional expression

Narratives of Somatizing and Non somatizing Patients in a Primary Care Setting

Somatizing patients, who comprise approximately 20 percent of the primary care population, often present physicians with recurrent but confusing combinations of symptoms without organic explanations. Illness narratives presented during initial medical encounters with primary care physicians were examined qualitatively to determine if the narrative structure, chronological development of symptoms and temporal frame differed between somatizing and non-somatizing patients. Following a structured interview to identify somatization tendency and co-morbidities of depression and post-traumatic stress disorder, 116 patients' encounters with primary care physicians were video-recorded and transcribed. Somatizers demonstrated a narrative structure that was similar to that of non-somatizing patients, but they used a thematic rather than a chronological development of symptoms and they did not convey a clear time frame. Somatizing patients with a co-morbid psychological condition focused on concrete physical sensations, were unable to provide contextual history or chronological organization, and did not develop a temporal frame. The narratives of somatizing and non-somatizing patients differed sufficiently to warrant further research for use as a clinical aid in the diagnosis of somatization.

Conversation analysis and interpretive quantitative research on psychotherapy process and problematic interpersonal behavior

In this article, I examine conversation analysis, a fruitful area of qualitative research, in order to extend my prior explorations of the idea that quantitative methods can and should be part of the repertoire of interpretive approaches employed by investigators committed to treating psychological phenomena as irreducibly meaningful. My examination includes considering several lines of research by investigators who are not practitioners of conversation analysis in which quantitative methods were employed to study patient behavior in psychotherapy and defensive behavior more generally. These lines of inquiry show that (a) quantitative research methods have a good deal to offer practitioners of conversation analysis as they endeavor to advance our understanding of the organization of interactions, and (b) we can employ quantitative methods and continue to embrace a commitment to interpretive inquiry. I also offer a critique of fundamental methodological precepts associated with conversation analysis, which differ notably from the precepts guiding most qualitative research efforts in psychology. In a fascinating twist, these precepts, which include discomfort with interpretive research procedures, have resulted in limitations in very recent attempts by some practitioners of conversation analysis to employ quantitative methods in their investigations.

Acknowledging problematic voices: processes occurring at early stages of conflict assimilation in patients with functional somatic disorder

OBJECTIVES

This study elaborates the assimilation model's account of client processes at an early stage (Level I). This model describes therapeutic change as a gradual assimilation of problematic experiences, or voices, into the client's personality. The Assimilation of Problematic Experiences Scale (APES; Stiles et al., 1991) measures client's increasing ability to recognize, accept and utilize these previously avoided voices.

DESIGN AND METHODOLOGY

Two researchers rated session excerpts from two psychotherapy cases, where the 'problematic voice' (PV) was initially unassimilated. Passages rated at APES Level I, along with their verbal assimilation descriptions, were later scrutinized for change processes. Voice dynamics within each passage were detailed and reviewed, to hypothesize substage processes representing movement. Both procedures involved a convergence process: raters first independently analysed, then shared their findings over successive rounds.

CONCLUSIONS

Across cases, shifts in the quality of negative affect were evident. Anxiety increased throughout this stage, as clients began to sustain exposure to intrusive problematic experiences. Later, Level I substages also showed an increase in conscious apperception of dominant voice characteristics including its resistance to experiencing PVs. Together, these relatively subtle changes indicated clients' increasing ability to familiarize themselves with PV qualities and recognize their historic defences against them, prior to identifying and accepting them as part of their personalities.

What is Interpersonal Behavior? A Post-Cartesian Approach to Problematic Interpersonal Patterns and Psychotherapy Process

Most efforts to learn about interpersonal behavior reflect a shared set of key commitments. These commitments, in turn, reflect the Cartesian framework with its split between person and world. Guided by the recent work of certain developmental psychologists interested in social interaction (e.g., Fogel, 1993 ; Kaye, 1985 ) and by an alternative philosophical perspective that regards the person's involvement in practical activities as fundamental ( Heidegger, 1962 ; Merleau-Ponty, 1962 ; Wittgenstein, 1958 ), the author maps out the participatory model of interpersonal behavior. According to this model, interpersonal behaviors are viewed as a person's contributions to doing something with other people. The author considers the model's implications for research by clinical psychologists on problematic behavior patterns in adults and psychotherapy process. The author also considers implications of rejecting the Cartesian framework for methodological concerns about the role of interpretation in research on interpersonal behavior.

Configurational analysis for case formulation

Diagnosis by DSM-IV is seldom sufficient to the task of planning and conducting treatment by psychotherapy. Formulation is vital for the task. I have developed a formulation approach called configurational analysis, and usually employ this tool in my work with individual adult cases. However, in this paper, I have also applied it to an evaluation session of a small, three-person family.