Positioning Shifts From Told Self to Performative Self in Psychotherapy

According to Positioning Theory, participants in narrative interaction can position themselves on a representational level concerning the autobiographical, told self, and a performative level concerning the interactive and emotional self of the tellers. The performative self is usually much harder to pin down, because it is a non-propositional, enacted self. In contrast to everyday interaction, psychotherapists regularly topicalize the performative self explicitly. In our paper, we study how therapists respond to clients' narratives by interpretations of the client's conduct, shifting from the autobiographical identity of the told self, which is the focus of the client's story, to the present performative self of the client. Drawing on video recordings from three psychodynamic therapies (tiefenpsychologisch fundierte Psychotherapie) with 25 sessions each, we will analyze in detail five extracts of therapists' shifts from the representational to the performative self. We highlight four findings:

• Whereas, clients' narratives often serve to support identity claims in terms of personal psychological and moral characteristics, therapists rather tend to focus on clients' feelings, motives, current behavior, and ways of interacting.

• In response to clients' stories, therapists first show empathy and confirm clients' accounts, before shifting to clients' performative self.

• Therapists ground the shift to clients' performative self by references to clients' observable behavior.

• Therapists do not simply expect affiliation with their views on clients' performative self. Rather, they use such shifts to promote the clients' self-exploration. Yet, if clients resist to explore their selves in more detail, therapists more explicitly ascribe motives and feelings that clients do not seem to be aware of. The shift in positioning levels thus seems to have a preparatory function for engendering therapeutic insights.

Doctors' questions as displays of understanding

Based on German data from history-taking in doctor-patient interaction, the paper shows that the three basic syntactic types of questions (questions fronted by a question-word (w-questions), verb-first (V1) questions, and declarative questions) provide different opportunities for displaying understanding in medical interaction. Each syntactic question-format is predominantly used in a different stage of topical sequences in history taking: w-questions presuppose less knowledge and are thus used to open up topical sequences; declarative questions are used to check already achieved understandings and to close topical sequences. Still, the expected scope of answers to yes/no-questions and to declarative questions is less restricted than previously thought. The paper focuses in detail on the doctors' use of formulations as declarative questions, which are designed to make patients elaborate on already established topics, giving more details or accounting for a confirmation. Formulations often involve a shift to psychological aspects of the illness. Although patients confirm doctors' empathetic formulations, they, however, regularly do not align with this shift, returning to the description of symptoms and to biomedical accounts instead. The study shows how displays of understanding are responded to not only in terms of correctness, but also (and more importantly) in terms of their relevance for further action.