Anssi Peräkylä

University of Helsinki | HY · Department of Social Research

The article describes the practices through which patients’ self-presentations are challenged in psychotherapy. Based on the analysis of thirty-eight instances from psychodynamic psychotherapy and psychoanalysis, analyzed with methods of conversation analysis, narrative analysis, and coding, this article reports on how therapists challenge patients...

Telling a story to a disengaged recipient induces stress and threatens positive self-image. In this study, we investigated whether storytellers with overly positive and fragile self-images (e.g., individuals with grandiose and vulnerable narcissism) would show heightened behavioral, emotional, and psychophysiological reactivity to recipient disenga...

Previous research shows that individuals exhibit overall lower engagement during video calls compared to face-to-face conversations, indicated by delayed and less frequent turn-transitions. In face-to-face interactions, a lack of engagement from co-participants is known to cause physiological stress in the active speaker. Whether similar influences...

During psychiatric diagnostic interviews, the clinician’s question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By...

In this study, we investigate how personal experiences about shameful events are described in face‐to‐face social interaction, and how these stories differ between participants who have either high or low levels of narcissistic personality traits. The dataset consists of 22 dyadic conversations where the participants describe events where they felt...

This Special Issue takes up the emergent topic of facial gestures in talk-in-interaction within multimodal CA, offering a collection of papers by linguists and social scientists who study the social meanings and interpretations of facial gestures. It aims to broaden our understanding of the impact of facial gestures for interlocutors' mutual unders...

Telling a story to a disengaged recipient induces stress and threatens positive self-image. In this study we investigated whether grandiose and vulnerable narcissism associated with overly positive and fragile self-image increase storytellers’ behavioral, emotional, and psychophysiological reactivity to recipient’s disengagement. Building on Bavela...

A personality disorder (PD) diagnosis can be considered by a patient to be stigmatizing. This presents interactional challenges for the clinician who makes the diagnosis and communicates it to the patient.Through an analysis of video-recorded clinical interviews of PD patients, we explore the anticipation and delivery of the diagnosis in psychiatry...

Using concepts developed by Goffman and the theory of inter-corporeality, this paper describes non-speaking spouses' responses to complaints made about them by the other spouse in the context of couple therapy first consultations. While the turn-taking system of couple therapy effectively precludes the possibility of a direct verbal response, non-s...

Continued interest in the distinction between grandiose narcissism, vulnerable narcissism and the fluctuation between grandiose and vulnerable states has expanded the repertoire of self-report instruments. The present study examined the psychometric properties of four brief narcissism measures [the Narcissistic Personality Inventory-13 (NPI-13), Hy...

In psychotherapy, the envisioned change in patient's feelings, thoughts and behaviour often targets their self-experience. This threatens simultaneously the patient's face and the therapeutic relation. We focus on face-threats in transformative question-answer sequences where therapists question the patient's face by shifting the focus of talk on p...

In seiner Zeit als Professor an den Universitäten in Berkeley (1958-1968) und Philadelphia (1968-1982) hatte Goffman eine Reihe von „graduate students“, die er bei der Arbeit an ihren Dissertationen (mit)betreute. Einige von ihnen führten in seiner Tradition ethnographische Studien über das soziale Leben in öffentlichen Räumen, über sozialen Gemein...

What does it mean to claim that somebody’s personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians’ and the patients’ approaches to generali...

Intersubjectivity is a complex concept, and some central approaches to it have been discussed in areas of, for example, philosophy (based on e.g. early work by Schuetz 1953), developmental psychology (Trevarthen & Aitken 2001), neuroscience (Iacoboni 2008) and primatology (Tomasello 2008; Tomasello, Carpenter & Hobson 2005). In the realm of the int...

In a longitudinal conversation analytical (CA) case study, we examined patient engagement in a psychiatric assessment process (nine clinical interviews) with a young woman who eventually received the diagnosis of personality disorder. Based on Goffman, we consider engagement in interaction as consisting of three facets: engagement in the action at...

Objective: In storytelling environments, recipients' questions have mainly been described as non-affiliative. This article examines how the topicality of story-responsive questions relates to the recipients' displays of affiliation. Furthermore, we investigate whether there are differences between the practices of neurotypical participants (NT) and...

In psychiatric diagnostic interviews, a clinician's question designed to elicit a specific symptom description is sometimes met with the patient's self-disclosure of their subjective experience. In shifting the topical focus to their subjective experiences, the patients do something more or something other than just answering the question. Using co...

Erving Goffman has argued that the threat of losing one's face is an omnirelevant concern that penetrates all actions in encounters. However, studies have shown that compared with neurotypical individuals, persons diagnosed with autism spectrum disorder can be less preoccupied with how others perceive them and thus possibly less concerned of face i...

Therapeutic alliance is a central concept in psychotherapeutic work. The relationship between the therapist and the patient plays an important role in the therapeutic process and outcome. In this article, we investigate how therapists work with disaffiliation resulting from enduring disagreement while maintaining an orientation to the psychotherape...

The study demonstrates how asymmetries in therapists’ affiliations with spouses emerge and are addressed in couple therapy. A total of 4 video-recorded couple therapy first sessions were subjected to conversation analysis. The moment-by moment interactions that contribute to one sided affiliation, as well as the therapists’ ways of managing such as...

Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman’s micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a...

Psychotherapy is geared to facilitate positive change in clients Many types of psychotherapy aim to do this by helping clients to get more in touch with their problematic emotions and their ability to self-reflect. However, it is not only the client's inner experience that changes during the process of psychotherapy, but also the relationship betwe...

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...

The article demonstrates two parallel yet interlinked accounts on quality: in conversation analysis (CA) and in interpersonal process recall (IPR). We illustrate our argument with data coming from couple therapy. CA was used to examine asymmetry in the therapist’s affiliation with the two spouses, whilst IPR offered means to explore the therapist’s...

We examined the emotional and psychophysiological underpinnings of social interaction in the context of autism spectrum disorder, more specifically, involving participants diagnosed with Asperger syndrome (AS). We recorded participants’ autonomic nervous system (ANS) activation (electrodermal activity, heart rate, and heart rate variability) and fa...

The starting point of conversation analytical research on psychotherapy was in Kathy Davis’s work on problem reformulations in the mid 1980s. Since then there has been a growing body of analysis of psychotherapy, based on the close, sequential relations between adjacent utterances. Through examples drawn from CA studies on psychotherapy in the past...

The author, who is a sociologist and psychoanalyst, comments upon Wooffitt’s analysis of poetic confluence. Using conversation analysis of moments of interaction where one interlocutor says something that bears a strong resemblance to what has just been in the mind of the other interlocutor, Wooffitt suggests that this form of communication has its...

Objective: With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians’ practices for offering patients opportunities t...

The study demonstrates how motherhood gender‐related discourse is intertwined with the ways in which the systemic techniques and systemic thinking are realised in the session. This research explores the consequences of gender‐related discourse commonly co‐constructed by participants in couple therapy and not recognised or challenged by the therapis...

In her influential paper on stance, alignment, and affiliation in conversational storytelling, Tanya Stivers argued that two basic conversational means of receiving a story, nods and vocal continuers, differ in their function: whereas vocal continuers display alignment with the telling activity, nods, during the mid-telling, convey affiliation with...

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 el...

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and hea...

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...

Psychological radio counselling is a relatively recent development in psychological practice, where professionals provide psychological help via mass media communication. In the media context, a professional and a help-seeker face a number of communicative challenges, one of which is to close the encounter meaningfully with regard to its counsellin...

We compared the patterns of affiliative and dominant behavior displayed in male dyads where one participant has Asperger's syndrome (AS) with those displayed in male dyads with two neurotypical (NT) participants. Drawing on interpersonal theory, according to which affiliation and dominance constitute two orthogonal axes of the " interpersonal circl...

We studied behavioral matching during joint decision making. Drawing on motion-capture and voice data from 12 dyads, we analyzed body-sway and pitch-register matching during sequential transitions and continuations, with and without mutual visibility. Body sway was matched most strongly during sequential transitions in the conditions of mutual visi...

Conversation analysis (CA) was started by Harvey Sacks and his coworkers at the University of California in the 1960s. It is a method for investigating the structure and process of social interaction between humans. Focusing on talk as well as on the nonverbal aspects of interaction, CA studies use video or audio recordings of naturally occurring i...

What makes possible the co-creation of meaningful action? In this paper, we go in search of an answer to this question by combining insights from interactional sociology and enaction. Both research schools investigate social interactions as such, and conceptualise their organisation in terms of autonomy. We ask what it could mean for an interaction...

Psychotherapy is done through interaction between the therapist and the client. Obviously, the ways in which psychotherapists interact with their clients are very much informed by the psychotherapeutic schools that the therapists represent. On the other hand — like interaction in any institutional context — also, psychotherapy, in its various forms...

In conversational storytelling, the recipients are expected to show affiliation with the emo- tional stance displayed by the storytellers. We investigated emotional arousal-related auto- nomic nervous system responses in tellers and recipients of conversational stories. The data consist of 20 recordings of 45- to 60-minute dyadic conversations betw...

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client's experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of...

Through the analysis of conversational interaction and clinical notes, this article develops conceptual linkages between the Goffmanian con- cept of face and the psychoanalytic and psychiatric understandings of narcissism. Self-cathexis—the investment of libidinal emotion to the image of self—is a key issue both for Goffman and in psychoanalytic st...

This article examines how speakers and hearers collaborate to modify their shared emotional stances in mundane dyadic conversations. Our purpose is to determine how the recipient’s facial expression of emotion during or immediately following the speaker’s utterance contributes to the talk. Such facial expressions do not simply mirror the speaker’s...

Therapeutic discourse is interaction between professional and client aimed at improving the client's mental health. In psychotherapy, therapeutic discourse is the central activity, as the aim of the therapists is to talk in ways that improve the client's mental health. There are two rather different research traditions that focus on therapeutic dis...

In this perspective article, we consider the relationship between experience sharing and turn-taking. There is much evidence suggesting that human social interaction is permeated by two temporal organizations: (1) the sequential framework of turn-taking and (2) the concurrent framework of emotional reciprocity. From this perspective, we introduce t...

Occasionally in conversation, a participant starts to frown during a silence between utterances, before starting to talk. The purpose of our study was to determine how these frowns contribute both to the upcoming turn and to the larger conversational context. The results suggest that these frowns mark the following utterance as dealing with somethi...

Earlier research has shown that conversational storytelling is a regular locus for displays of affective stance. A stance display by the teller invites a mirroring response from the recipient, and these reciprocal displays are finely organized and timed. The article adds a new aspect to the research on affective stance and affiliation by examining...

All social life is based on people’s ability to recognize what others are doing. Recently, the mechanisms underlying this human ability have become the focus of a growing multidisciplinary interest. This article contributes to this line of research by considering how people’s orientations to who they are to each other are built-in in the organizati...

Objective: Despite an increasing recognition of the relevance and significance of self-compassion processes, little research has explored interventions that seek to enhance these in therapy. In this study, we examined the compassionate self-soothing task of emotion-focused therapy involving two-chair work, with seven clients. Method: Conversatio...

Objective: To investigate the prosodic aspects of therapists' empathic communication. Method: 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis were analysed using conversation analysis. Results: Two interactional trajectories where the therapists either validated the clients' emotions or challenged them were identified....

The uses of formulation in cognitive psychotherapy and psychoanalysis were compared, by means of conversation analysis, using 53 audio-recorded sessions as data. Two formulation types were found in both approaches: highlighting formulations, which recycle the client’s descriptions and recognize therapeutically dense material, and rephrasing formula...

Sometimes in conversation, a participant begins to smile during a silence that occurs between utterances. The purpose of our study was to determine how these smiles contribute to the upcoming turn as well as to the larger conversational context. The results suggest that these smiles can work as a first step in the construction of an emotional trans...

In natural conversation, the minimal gaps and overlaps of the turns at talk indicate an accurate regulation of the timings of the turn-taking system. Here we studied how the turn-taking affects the gaze of a non-involved viewer of a two-person conversation. The subjects were presented with a video of a conversation while their eye gaze was tracked...

Psychotherapy is a 'talking cure'- clients voice their troubles to therapists, who listen, prompt, question, interpret and generally try to engage in a positive and rehabilitating conversation with their clients. Using the sophisticated theoretical and methodological apparatus of Conversation Analysis - a radical approach to how language in interac...

The chapter shows how facial expressions are used in pursuing emotional responses to tellings. The data come from five dyadic conversations over lunch, recorded by three cameras. Sometimes a story, an announcement, or other telling, that is designed to convey the speaker's emotional stance towards what is told, is not met by the recipient's immedia...

The importance of emotion in everyday interactions has been acknowledged by researchers in a wide variety of disciplines, including linguistics, sociology, social psychology, anthropology, and communication. This book offers a collection of original studies that explore emotion in naturally occurring spoken interaction. The chapters examine both th...

Someone's “deontic authority” is their right to determine others' future actions. It can be acquiesced to or resisted. This article introduces, more systematically than before, the concept to close examination of talk-in-interaction. Drawing on video recordings of planning meetings as data and on conversation analysis as a method, we examine two cl...

Using 58 audio recorded sessions of psychoanalysis (coming from two analysts and three patients) as data and conversation analysis as method, this paper shows how psychoanalysts deal with patients’ responses to interpretations. After the analyst offers an interpretation, the patient responds: at that point (in the “third position”), the analysts re...

Therapeutic work with the client's present moment experience in existential therapy was studied by means of conversation analysis. Using publicly available video recordings of therapy sessions as data, an existential therapist's practice of guiding a client into immediacy, or refocusing the talk on a client's immediate experience, was described and...

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist's conclusion and the patient's response to it. In the conclusions, the therapist investigates and challenges the patient'...

Using conversation analysis as a method, we examine patients' responses to doctors' treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors' 'unilateral' decision delivery (Collins et al. 2005). In line with Collins et al., we s...

The topic of this chapter is almost embarrassingly self-referential. I would certainly have declined the invitation to write it, had I not agreed with the editor that the curious situation I find myself in — as academic and practitioner — fitted peculiarly well with the theme of this book. If there is a chance that a personal account of my work mig...

Psychoanalytic interpretation is normally understood as a sequence of two utterances: the analyst gives an interpretation and the patient responds to it. This paper suggests that, in the interpretative sequence, there is also a third utterance where psychoanalytic work takes place. This third interpretative turn involves the analyst's action after...

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 explo...

This article reports a conversation analytic study of patients' resisting responses after doctors' diagnostic statements. In these responses, patients bring forward information that confronts the doctor's diagnostic information. We examine two turn formats - aligning and misaligning - with which patients initiate resistance displays, and describe c...

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 professional's non-neutrality functions...

Based on conversation analysis (CA) of audio-recorded therapy sessions, the article explicates practices of responding to the patient's emotional experience in cognitive-constructivist psychotherapy. First, the article describes two types of therapist's actions after the patient's descriptions of an emotional experience: recognition and interpretat...

This article reports a conversation analytic study of primary care physicians' orientations to different types of patients' problem presentation. Four types of problem presentation are examined: 1. symptoms only; 2. candidate diagnosis; 3. diagnosis implicative symptom description; and 4. candidate diagnosis as background information. The analysis...

This article examines the intertwining of facial and verbal expressions in assessing stories and topics. The main focus is on the facial expressions of the speaker of a story or telling that occur before their verbal evaluation. It is shown how speakers and recipients arrange face and talk in different configurations in order to display their stanc...

The Oxford English Dictionary defines modern psychotherapy as "the treatment of disorders of the mind or personality by psychological or psychophysiological methods." The common assumption is that, in psychotherapies, the means of healing is talk. Not all talk is therapeutic, and the history of psychotherapy involves not just formulating new psych...

The aim of this chapter is to present a systematic overview of some of the research results presented in this book. An overview like this cannot cover all that was important in the preceding chapters, but it will bring out something from each. We present the key results in Table 11.1. We then unpack the contents of the table, and, by setting them a...

In this chapter, I will use conversation analysis to explore some themes that are central in the clinical theory and practice of psychoanalysis. These themes include interpretation (which is a central theme in classical psychoanalytic theory), and affect and intersubjectivity (which are central themes in some contemporary psychoanalytic discussions...

Conversation analysis (CA) is a method for investigating the structure and process of social interaction between humans. It focuses primarily on talk, but integrates also the nonverbal aspects of interaction in its research design. As their data, CA studies use video or audio recordings made from naturally occurring interaction. As their results, C...

In the literature on medical consultations, there are two strikingly different ways of thinking about the relation between doctors and patients. One emphasizes the doctor’s authority, while the other, often programmatically, emphasizes the patient’s knowledgeability and his or her participation in the diagnostic procedure and the decisions about th...

Earlier research It is widely acknowledged that issues of lifestyle-such as diet, drinking, smoking, and exercise-have a significant impact on the health of individuals, and that promoting healthier patient lifestyle choices is an important task for primary care doctors. In spite of its importance, this part of the consultation has been focused upo...

The paper reports a conversation analytical study of patients' responses to interpretations in psychoanalysis. The data come from 27 tape-recorded and transcribed psychoanalytic sessions involving three analyst-patient dyads. The study seeks to facilitate dialogue between conversation analytical (CA) findings and psychoanalytic theory by using CA t...

Twenty-seven psychoanalytic sessions were tape-recorded and transcribed with the aim of describing key aspects of the psychoanalytic technique as they appear in these recordings. The method of the study, which included 2 experienced analysts and their 3 patients, was conversation analysis. This study focuses on interpretations that make links betwe...

In order to study activity in conducting brief alcohol intervention, a total of 83 consecutive consultations by eight general practitioners were videotaped. The categorization included the nature of the patient's health problems and whether alcohol consumption was elicited. The discussions were compared to previously given instructions. Alcohol con...

The paper compares Bales' Interaction Process Analysis (IPA) with Sacks' Conversation Analysis (CA), arguing that CA has answered several questions that originally motivated the development of IPA, and while doing so, it has re-specified the phenomena of interaction research. These two research traditions are in many ways diametrically opposed: the...

Some institutional settings, such as therapeutic or counselling settings, involve normative models, theories or quasi-theories concerning professional–client interaction. These models and theories can be found in professional texts, in training manuals and in written and spoken instructions delivered in the context of professional training or super...