Researching Client and Therapist Interactions:
Conversation Analysis as a Practice-Based, ExtraTherapeutic Perspective
Sarah Cantwell
Dr John Rae
Department of Psychology, University of Roehampton
NICE or not so NICE? Conference
May 28th, 2015
Presentation Aim
•
To demonstrate how a consideration of CA findings can contribute to reflections on
the notion of ‘evidence’.
–
•
Focus on the practice-based and extra-therapeutic nature of CA findings.
Demonstrate by illustrating some initial findings from my PhD research.
S. Cantwell, J. Rae
CA as a Practice-Based, Extra-Therapeutic Perspective
Illustrative Findings (1)
• Data: audio-recordings of Pluralistic Therapy for Depression sessions (Cooper & McLeod, 2011).
• Broad Therapeutically-Informed Data Selection Criterion: client and therapist talk
regarding therapeutic methods and solutions.
• CA Focus: features of interactions that people manifestly orient to when
responding to each other
(Peräkylä et al., 2008).
– Noticed Phenomenon: Therapist’s questions to clients about therapeutic
methods/solutions.
•
Treated by client and therapist as ‘non-straightforward’
•
12 cases so far – findings indicative, not yet finalized.
•
Found across 4 out of 5 dyads and in 9 out of 20 sessions sampled to date.
•
Only occur in the second half of 50 minute sessions.
•
Maximum of 2 of these questions found in any session.
•
To date, I’ve only sampled the first 6 sessions for each dyad.
S. Cantwell, J. Rae
CA as a Practice-Based, Extra-Therapeutic Perspective
Illustrative Findings (2): Question treated by client and therapist as ‘straightforward’
1
C:
and you can be far more dispassionate and ↑th#at's the place that
2
#I ↑w#ant to ↑b#e::
3
(0.3)
4
C:
5
T:
6
C:
7
T:
M[hm
M↑Hm:m=
=Yea:h
(2.5)
T:
10
11
12
•Question designed as ‘on-topic’ (‘and’, ‘that’)
•No comments on the question itself (by therapist or client).
[Dis]passionate.
8
9
]
And ↑what makes that difficult.
(6.0)
C:
It's being too ruled by emotions .hh ↑and (0.5) always wanting to
be:: ac:cepted.
Substantial response by client.
Illustrative Findings (3): Question treated by client and therapist as ‘non-straightforward’
1
2
(0.3)
T:
.HH So WHAT- >I mean IN TERMS of the THERapy here< what's what's
3
your: sense of it, wh- wh- wh- what's your thinking about what
4
you'd like to °do°.
5
C:
6
7
.HHH H
•‘so’-preface launches a new topic,
unprompted by just-prior talk (Bolden, 2009).
•‘I mean’-prefaced insertion => treating the
scope of the question as unclear.
•Tentative design (insertion, repeats)
(1.0)
C:
8
°.shih°
No client
response
(1.9)
9
T:
Or I could tell you my thoughts.
10
C:
↑Yeah, I'd be interested in you[r
11
T:
12
13
tho]ughts, I mean-
Therapist indirectly references
question by offering to answer it.
[°'kay°]
(0.4)
C:
14
↓Very generally just- (.) °what I'd said before°, just- .hh (0.3)
a little help-ing hand would be: (0.4) rea:ll[y ]
15
T:
16
C:
[°O]kay°
Appreciated. And if .hh if it could help ↑others as ↑wel:l,
((client continues turn))
Client collaborates
with change of
topic.
Illustrative Findings (4): Question treated by client and therapist as ‘non-straightforward’
1
C:
2
T:
3
C:
4
T:
5
C:
hh. .shhih
6
T:
h. And I guess and ↑how- ↑how can you do that?
7
C:
°.shhhih M::m° (0.9) °brain transpl[ant°
8
T:
9
C:
10
C:
((client continues turn)) With those e↑motions. [I want it to]
[Ye:ah
]
be the ↑#other #way #a↑round SHHih. HEHH[h ]
[Ye]:ah
• ‘And I guess’ makes shift from
‘telling’ to ‘solving’ less
disjunctive.
• Tentative design (repair,
repeats)
Non-serious response
]
[heh heh] [heh hah hah] hah
[hih hah hah]
°Oh God° .hh hh (0.8) I don't kno:w. (1.1) ↑Being in a state
11
of hypervigilence all the ↑time, and then sitting down and
12
examining every emotion and .hh whether it's valid or just (.)
13
non↑sense h. (1.2) °that sounds a hell of a lotta wo[rk°]
Initial nonanswer
response.
Illustrative Findings (5): SUMMARY - questions
about therapeutic methods/solutions
• Involve a shift from the prior topic/action to therapeutic
methods/solutions.
– Resources available to therapist for making this shift more/less disjunctive.
• Oriented to as ‘non-straightforward’.
• The client may not immediately substantially respond, but does generally
collaborate with the shift to therapeutic methods/solutions.
S. Cantwell, J. Rae
CA as a Practice-Based, Extra-Therapeutic Perspective
Contributions by CA findings to reflections on the notion of ‘evidence’ (1)
Findings are firmly ‘practice-based’:
– Detailed findings based on observation
– Focus on features the people themselves oriented to during the interaction.
– Remain close to the interactional features – little idealization/abstraction.
‘Evidential’ reflection #1: Interactionally-focused findings from practice-based
research, such as CA, have immediate relevance for practice and training.
S. Cantwell, J. Rae
CA as a Practice-Based, Extra-Therapeutic Perspective
Contributions by CA findings to reflections on the notion of ‘evidence’ (2)
‘Practice-based’ research => extra-therapeutic’ findings , which stand independently of existing psychotherapeutic
theories and variables.
•
Can engage in multi-faceted ways with existing psychotherapy theories and research (Peräkylä & Vehviläinen, 2003)
–
Corroborate existing descriptions of ‘metatherapeutic communication’
–
Elaborate previously unnoticed, tacit features in interactions (Polkinghorne, 1999; Schön, 1987; Madill, 2015)
(Cooper et al., forthcoming).
e.g. ‘tentative design’ => management of topic/action ‘shift’.
–
Useful for researchers beyond the Pluralistic Therapy research stream?
‘Evidential’ reflection #2: ‘extra-therapeutic’ findings have a multi-faceted potential for contributing to existing
counselling and psychotherapy research.
‘Evidential’ reflection #3: ‘Extra-therapeutic’ findings can distinctly contribute to ongoing research by highlighting
some tacit features of counselling and psychotherapy practice.
S. Cantwell, J. Rae
CA as a Practice-Based, Extra-Therapeutic Perspective
References
Peräkylä, Antaki, Vehviläinen & Leudar (eds.) (2008). Conversation Analysis and Psychotherapy. Cambridge
University Press, Cambridge.
Bolden, G. B. (2009). Implementing incipient actions: The discourse marker ‘so’in English conversation. Journal of
Pragmatics, 41, 974-998.
Cooper, M., Dryden, W., Martin, K. & Papayianni, F. (forthcoming). Metatherapeutic communication and shared
decision-making. In M.Cooper & W.Dryden. Handbook of Pluralistic Counselling and Psychotherapy.
Cooper, M., & McLeod, J. (2011). Pluralistic Counselling and Psychotherapy. London: Sage.
Madill, A. (2015). Conversation Analysis and Psychotherapy Process Research. In Psychotherapy Research (pp.
501-515). Springer Vienna.
Peräkylä, A., & Vehviläinen,(2003). Conversation analysis and the professional stocks of interactional knowledge.
Discourse and Society, 14, 727-750.
Polkinghorne, D. (1992). Postmodern epistemology of practice. In S. Kvale (Ed.), Psychology and Postmodernism
(pp. 146–165). Thousand Oaks, CA: Sage.
Schön, Donald A. (1987). Educating the Reflective Practitioner. London: Jossey-Bass.