Rhythm and Blues - Amalie's 152nd session: From psychoanalysis to conversation and metaphor analysis - and back again

Formulation and Clients' Agency in Cognitive Behavioral Therapy

The experience of loss of agency is one of the reasons for clients to go for psychotherapy. Enhancing clients’ agency has been considered a fundamental factor for successful treatment in psychiatry and psychotherapy, yet few studies have investigated the interactional realization of how therapists do this in authentic psychotherapeutic encounters. Drawing on audio-recorded talk-in-interaction between clients and psychotherapists in cognitive behavioral therapy (CBT) encounters at a mental health center in China, this paper uses the method of conversation analysis to demonstrate how therapists ascribe agency positions to clients by issuing formulations of what the clients have just said. Two types of formulation were identified: affirmative formulations and challenging formulations. In the first type, the therapists highlight the positive aspect of the clients’ description of their experiences and ascribe an agentic position to the clients. In the second, the therapists challenge the clients’ implausible views and their non-agentic positioning of themselves. This study shows that the therapists’ formulation could be employed to manage the epistemic difficulties associated with claiming knowledge about the clients’ inner states and assessing their feelings. In this sense, the formulation is a robust interactional device in negotiating epistemic problems in addressing the clients’ experiences and promoting their agency in therapy. However, it is noteworthy that in the challenging formulation, therapists claim privileged access to the clients’ knowledge domain and challenge their prior epistemic status, which might run the risk of engendering clients’ resistance.

Practices of joint meaning creation. Dreams in psychoanalytic discussion

Using conversation analysis of audio recorded psychoanalytic sessions, this article investigates dream interpretation as conversational practice. We focus on the ways in which the "real world" meanings of objects or events in the dream are collaboratively created. Three routes for the meaning creation were found. (1) In plain assertions, either the analyst or the patient asserts the meaning of a dream element, for example stating that the cow in the dream means women. (2) In meaning creation through redescription, the analyst describes anew events belonging to the real world or the dream, which have been referred to in the earlier conversation. This redescription makes possible the subsequent assertion of explicit linkages between the dream and the real world. (3) In the merging of referential worlds, the analyst extends the patient's real-world description with images that are recognisably from the dream: the world of the dream and the real world are thus momentarily merged. In discussion, we point out that in our audio recorded data, the dream interpretation does not primarily involve revealing repressed and unconscious ideas, but rather it involves reminding the patient of something that the patient already knows but is reluctant to think or talk about.

Doing Contrariness: Therapeutic Talk-In-Interaction in a Single Therapy Session With a Traumatized Child

Conversation analysis (CA) of children-adult-interaction in various contexts has become an established field of research. However, child therapy has received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley, 2006). Psychotherapy process researchers in adult therapy (Stiles et al., 2015) have found that therapists "invent" a new therapy for each patient (Norcross and Wampold, 2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of "unexplainable rage." The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe "doing contrariness," as a conversational practice producing epistemic and affiliative disruptions, while "avoiding doing contrariness" and "remedying contrariness" are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding.

Psychodynamic Psychotherapy Process Research: A quick ride through what you should know about process (research)

This paper gives an overview of psychoanalytic process research, which brings to light the complexity of psychotherapy sessions. This complexity is so rich that many instruments intended to make the process measurable failed in the past because they initially used a strategy of complexity reduction. This method however did not help to further our understanding of the complexity involved. Three former presidents of the Society for Psychotherapy Research (Stiles, Hill, Elliot 2015) decided to solve the following equivalence paradox: many therapies work successfully though they all follow different theories, produce a heterogeneity of processes and often enough a misfit between what theories maintain to be a good process and their realization in the treatment room. As theories are often compared to maps, a driver would wonder which route to take. But therapists-as-drivers go undaunted - and nevertheless achieve their goals together with their patients. Norcross and Wampold (2018) found that good therapists invent new therapies with every new patient. They hypothesize that it is because of conversation. This is in accord with the 3 former presidents' proposal to return to detailed single case analyses including the micro-analytic power of conversation analysis of which a few insights are outlined in this article.

Talking Cure Models: A Framework of Analysis

Psychotherapy is commonly described as a "talking cure," a treatment method that operates through linguistic action and interaction. The operative specifics of therapeutic language use, however, are insufficiently understood, mainly due to a multitude of disparate approaches that advance different notions of what "talking" means and what "cure" implies in the respective context. Accordingly, a clarification of the basic theoretical structure of "talking cure models," i.e., models that describe therapeutic processes with a focus on language use, is a desideratum of language-oriented psychotherapy research. Against this background the present paper suggests a theoretical framework of analysis which distinguishes four basic components of "talking cure models": (1) a foundational theory (which suggests how linguistic activity can affect and transform human experience), (2) an experiential problem state (which defines the problem or pathology of the patient), (3) a curative linguistic activity (which defines linguistic activities that are supposed to effectuate a curative transformation of the experiential problem state), and (4) a change mechanism (which defines the processes and effects involved in such transformations). The purpose of the framework is to establish a terminological foundation that allows for systematically reconstructing basic properties and operative mechanisms of "talking cure models." To demonstrate the applicability and utility of the framework, five distinct "talking cure models" which spell out the details of curative "talking" processes in terms of (1) catharsis, (2) symbolization, (3) narrative, (4) metaphor, and (5) neurocognitive inhibition are introduced and discussed in terms of the framework components. In summary, we hope that our framework will prove useful for the objective of clarifying the theoretical underpinnings of language-oriented psychotherapy research and help to establish a more comprehensive understanding of how curative language use contributes to the process of therapeutic change.

Interface between psychoanalysis and speech language and hearing sciences: a literature review

ABSTRACT The aim of this study was to verify the Brazilian and international scientific productions by correlating Speech Language and Hearing Sciences and Psychoanalysis. A literature review was performed using the databases BVS, Scielo, Scopus and PubMed. The used descriptors were “Fonoaudiologia”, “Psicanálise”, “Comunicação”, “Speech Therapy”, “Psychoanalysis” and “Communication”, identifying 65 full articles between the years 1980 and 2015. The analysis was performed using a “Protocol for article classification”. It was verified that Original Articles are the most published type, SCOPUS and BVS being the most common databases. There is a predominance of articles in the Portuguese language, followed by English, French and German. Several specialties of Speech Language and Hearing Sciences presented interface with Psychoanalysis, especially Language and Neuropsychology. The studies were published mainly in Psychology journals, also found in the area of audiology and interdisciplinary area. This review showed the psychoanalytic interference in speech language and hearing clinic, highlighting the need for further studies correlating both areas that may contribute to the work of these professionals and, consequently, enable an improvement in the quality of life of psychic subjects.