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Clients' and Therapist's Joint Construction of the Clients' Problems
Abstract
Then I proposed another construct, building further on the notion of complementarity. I did this by describing/transforming what they (the clients) defined as a conflict into a mechanism that served to balance their relationship. This description not only legitimized each of their personal styles; it also defined the reaction of each to the other's style as only natural . . . By means of these rather practical recommendations, I reinforced my proposal of an alternative description of their predicament [italics added].
... Children seldom occupy that role (Ackerman, 1970;Hutchby, 2002;Wolpert & Fredman, 1994). Parents' sense of poor agency explains why the narratives of the first few sessions are often problem-saturated (Gonçalves et al., 2010) and include blaming (Buttny, 1996). ...
... Talking about problems carries the risk of attributions of guilt (Buttny, 1996;Parker & O'Reilly, 2012) and thus the risk of loss of face for a participant. Offering "an account" of one's actions is one way of managing such problematic events. ...
... In presenting clients' problems, the therapist actively engages in how problems are narrated and stops clients from continually blaming others. Reformulation of the problem is often a necessary therapeutic intervention (Buttny, 1996.). ...
Children with conduct disorders are at risk of being positioned in the family therapy as 'the problem'. This study describes how the difficulties were talked about and how the child coped in this situation. The results showed: the parents produced symptom-oriented problem talk about the child's behavior, rendering systemic reformulation of the problem challenging. The negative interaction made the climate unsafe and impaired consideration of the child's behavior as a meaningful way for the child to become seen and heard. This study enriches understanding of the therapeutic challenge therapists face with high-risk families from the very beginning of the treatment.
... Although the key elements in IPC and IPT are the therapist's ability to perform case formulation and the correct choice of the interpersonal problem area (Ravitz, McBride, & Maunder, 2011), there has been no previous systematic research into the interactional ingredients of IPT or IPC case formulations. Previous research into other forms of therapy has emphasized the collaborative nature of case formulation and its joint construction (Buttny, 1996), but it has also been shown that case formulation is a complex interactional activity , and it is this reality that may explain the limited amount of direct evidence linking case formulation with outcome. However, meta-analyses have consistently linked the efficacy of psychotherapy with the quality of the therapeutic alliance, regardless of the therapeutic approach that is adopted Horvath, DelRe, Flückiger, & Symonds, 2011). ...
... If, on the other hand, no emotional bond or shared idea of the goals of the counselling could be formed during the initial sessions, this indicated that the patient would not benefit from the intervention . These findings are in line with those of Buttny (1996) and contribute to previous research by linking joint identification of the problem area with a positive outcome for the overall therapeutic process. At a general level this process refers to the philosophy of a language game, as put forward by Wittgenstein (1953), i.e. case formulation can be seen as a language-game in which a counsellor reformulates the patient's utterances for the purposes of therapeutic work. ...
The aim of this research was to optimize the use of effective treatment for patients
with depressive disorders in primary health care. The dissertation examines
whether brief treatment, Interpersonal Counselling (IPC), is appropriate for
treating depression, and which are the factors that may influence a positive
response to this counselling. This thesis consists of three studies based on the
same patient sample which was viewed on three levels: In Study I, 40 patients
with a diagnosis of major depressive disorder (mild or moderate) were
randomized into two groups, 20 of them receiving IPC (7 sessions) and 20 a
comparable treatment modality, Interpersonal Psychotherapy (IPT) (16 sessions).
Statistical analysis showed that IPC delivered by mental health nurses in primary
health care was comparable to IPT in secondary care. Approximately 60% of the
patients had recovered by the time of the 12 months follow-up in both groups.
Study II considered five IPC patients who had recovered and five who remained
unchanged. Qualitative content analysis and applied conversation analysis (CA)
of the case formulation process and its content in the initial phase of IPC
suggested three core conditions for recovery from depression: joint construction
of the problems by the patient and counsellor, the ability to restrict the scope to
one problem area and the availability of social support from close relationships
outside the treatment. In Study III the analysis of a recovered case indicated how
IPC’s interpersonal formulation approach and the focus within an IPC
framework were able to guide the patient away from her self-accusation talk
towards discussing her problematic relationship with her spouse. Overall, the
results presented here have important clinical and organizational implications
and support the conclusion that a significant proportion of major depressive
disorder patients can be treated with brief treatment in primary care. Training
front-line health care workers in psychotherapeutic skills could close the gap
between mental health needs and access to care.
... goals, problem definitions, interventions, question-answer sequences, interpretations) has become a recent focus of research (e.g. Buttny, 1996;Peräkylä, Antaki, Vehviläinen, & Leudar, 2008;Strong, 2007). What emerges from such research is a more nuanced sense of these transactions than what is conveyed by the crisp prose found in relating such 34 T. Strong et al. developments in counseling textbooks (e.g. ...
... They have also shown how identity is made relevant in specific social contexts, such as in youth subgroups (Widdicombe & Wooffitt, 1995), internet chatrooms (Giles, 2016), and in media interaction (Clayman, 2010;Pomerantz, 1989). CA has addressed how particular participant roles are constituted in institutional exchanges (Drew & Heritage, 1992), such as in education (Gardner, 2013), healthcare (Buttny, 1996;Gill & Roberts, 2013), advice (Butler, Danby, & Emmison, 2009;Peräkylä, 2013), in legal settings (Komter, 2013), in sales environments (Stokoe, Sikveland, & Humă, 2017), and in the way people establish their identities online (Giles et al., 2015). Studies have shown how identity is co-constructed in the use of categorization and person reference (i.e., what people call themselves and others) (Enfield & Stivers, 2007;Sacks, 1979), how they answer the phone (Drew, 2002), handle praise (Pillet-Shore, 2015;Speer, 2012), and selfdeprecate (Speer, 2019). ...
Conversation analysis (CA) is an empirical approach to the study of social life that takes interaction in context as its primary focus. It is fundamentally ethnomethodological in its concern to discover the methods people use to collectively organise and navigate the everyday social world. For CA, identity is something that people actively use, make reference to, and put to work, in order to bring about a social action or outcome, such as to establish or resist membership of a category or social group. CA has been used in the study of gender identities, race, family roles, youth subgroups, and chatrooms; in mainstream media interaction, in studies of institutional exchanges such as in education, healthcare, advice and legal settings, and in sales environments, both online and face to face. To see what and how identities are achieved, CA explores sequences of embodied interaction, the primary source of data, carefully recorded and transcribed, so that we can identify patterns, including in how people bring off and attribute certain characteristics to their own and others’ membership of particular identity categories. Detailed analyses of real interaction enable us to grasp how matters relevant to identity are raised, made relevant and dealt with in real time. In applying this approach we can observe and report on the kinds of identity problems that members are solving in the here and now. In this chapter we provide a brief survey of the development of an ethnomethodological and conversation analytic approach to identity and describe how it offers verifiable insights into the inventive capacity of people to make attributions and inferences of identity consequential to social actions. We offer an example of a conversation-analytic procedure, looking at how kinship carers handle matters of family identity in a support group environment. Kinship carers’ parental status is poorly understood and at times overtly challenged by others. In our analyses we demonstrate how kinship carers interactively establish recognisable attributes and features of a common and valid identity in their complaints about the actions and dispositions of absent third parties. We end by considering how an ethnomethodological CA approach contributes to identity research, its limitations and its future directions.
... When failing to mobilize the teacher's alignment, Maria instead refuses to answer and does a 'walk-out', leaving the room and the teacher. She simultaneously verbalizes her protest, but in the conflicts between the two parties, social accounts do not necessarily constitute a magical resource, as the mediator is cast in an in-between-position (see also Buttny 1996;Edwards 1995). ...
... Over the years discourse analysts have increasingly made therapy and counseling the target of their investigations. Research has not only focused on specific institutionalized social groups such as couples (Buttny 1993(Buttny , 1996(Buttny , 1998Edwards 1994Edwards , 1995Gale 1991;Kogan and Gale 1997;Muntigl 2004aMuntigl , 2004bMuntigl and Hadic Zabala 2006;Muntigl and Horvath 2005), children (Hutchby 2002), families (Aronsson and Cederborg 1994;Grossen 1996), "groups" (Wodak 1981(Wodak , 1986(Wodak , 1996, anorexic patients (Labov and Fanshel 1977), Aids patients (Peräkylä 1993(Peräkylä , 1995Peräkylä and Silverman 1991;Silverman 1994Silverman , 1997, and persons with psychiatric disorders (Fine 2006), but also on a range of psychotherapy schools, which include psychoanalysis (Billig 1999;Peräkylä 2004;Vehviläinen 2003), narrative therapy (Kogan and Gale 1997;Muntigl 2004aMuntigl , 2004b, cognitive behavioral therapy (Antaki, Barnes, and Leudar 2005), family systems therapy (Peräkylä 1995) Rogerian client-centered therapy (Weingarten 1990), and experiential therapy (Muntigl 2005). ...
Discourse-based research can shed much light on how therapy and counseling, as social activities, are accomplished. Looking at the details of social interaction can tell us something about how clients and therapists come to shared or divergent understandings of experience and how therapeutic goals are realized in the moment-to-moment unfolding of conversational actions. The bridge between a linguistic description of interaction and the psychological processes involved in therapy may in all probability still be “under construction”. The argument made here is that successful bridge building may best be accomplished by taking the details of talk into consideration, mainly because psychological processes are not independent of language structures. In fact, we may go so far as to say that phenomena such as “consciousness”, “identity”, “emotions”, “psychopathology”, and “development” are realized in the so-called micro, mundane, or everyday meaning making resources found in language and other semiotic systems. From this perspective, ignoring language means neglecting a significant area of how human sociality gets accomplished.
In order to topicalize the role of linguistics or language use, I draw my attention to a discursive practice that is centrally constitutive of therapy and counseling. The discursive practice of diagnostics, whether it is explicitly or implicitly realized through the use of everyday or technical terms, seems to be a component of most therapeutic activities. Although the term diagnostics, as in making a diagnosis, is sometimes equated with illness or pathology, I would interpret this term as referring more generally to how problems are socially constructed through language. In this way, diagnostics may involve the discursive construction of problems as a pathology that is internal to the organism, or equally, it may involve the discursive construction of a problem as socially shared.
In this chapter, I discuss how diagnostic practices in therapy and counseling have been described in the discourse analytic literature. I begin by addressing the issue of how therapy has come to be seen as a social activity that comprises a range of discursive practices or genres, one of which involves diagnostics. Following that is a discussion of the various studies addressing the issue of problem diagnosis, which is then complemented by an illustration of how problem diagnosis can get derailed or off-track. Lastly, I conclude this article by suggesting some future directions that research on diagnostic practices in therapy may take.
Bringing together cutting-edge research from a group of international scholars, this innovative volume examines how people with dementia interact with others in a variety of social contexts, ranging from everyday conversation to clinical settings. Drawing on methods from conversation analysis, it sheds light on how people with dementia accomplish relevant goals in interaction, as well as how changes in an individual's discursive abilities may affect how conversationalists negotiate a world in common and continue to build their social relationships. By exploring interaction, this book breaks new ground in challenging the commonplace assumptions about what constitutes typical or atypical interactions in communication involving people with dementia, and further demonstrates the unique and creative strategies all speakers employ to facilitate better and more collaborative communication. It is essential reading for academic researchers and advanced students across sociolinguistics, interactional linguistics and conversational analysis, as well as health care practitioners.
La investigación en el contexto de la terapia familiar y de pareja, como en el caso de otros modelos de terapia, se ha enfocado, desde hace varias décadas, en la dimensión de los resultados; sin embargo, más recientemente, la comprensión del proceso terapéutico y las intervenciones empleadas en el transcurso de su desarrollo, ha adquirido cada vez mayor relevancia. Dentro de éste campo de estudio destaca la relación terapéutica, específicamente en el ámbito de la alianza terapéutica y del proceso discursivo, como elemento cardinal en la generación de cambios y transformaciones presentes en el continuo del proceso terapéutico y en el cierre exitoso del mismo, que constata su eficacia. Al mismo tiempo, el entendimiento de estos dos ámbitos es fundamental para entender cómo se originan dichos cambios y qué factores intervienen en su producción. En esta reseña me propongo brindar una perspectiva del momento actual en la Investigación de Proceso, específicamente en lo que concierne a la alianza y al proceso discursivo, sintetizando los hallazgos empíricos, las definiciones y las construcciones teóricas asociadas a este campo de investigación.
Research in the context of family and couple therapy, as in the case of other models of therapy, has focused, for several decades, on the dimension of the outcomes; however, more recently, the understanding of the therapeutic process and the interventions used in the course of its development has become increasingly relevant. Within this field of study, the therapeutic relationship stands out, specifically in the field of the therapeutic alliance and the discursive process, as a cardinal element in the generation of changes and transformations present in the continuum of the therapeutic process and in the successful closure of it, that confirms its effectiveness At the same time, the understanding of these two areas is fundamental to understand how these changes occur and what factors intervene in their production. In this review, I intend to offer a perspective of the current moment in the process research, specifically with regard to the alliance and the discursive process, synthesizing the empirical findings, the definitions and the theoretical constructions associated with this research field.
Using the method of conversation analysis, this study has examined the sequential organization of empathic talk in psychotherapy, analyzed its turn design as well as investigated its variations on turn construction. The empathic sequence can be characterized as a four-part structure: (1) the therapist soliciting troubles/feeling telling from the client; (2) the client’s report on the troubles/feelings talk; (3) the therapist’s empathy, and (4) the client’s response. Moreover, in addition to its unmarked turn construction “empathic talk without prefacing”, this study has found empathic talk takes on other three types of turn construction including so-prefaced empathic talk, particle-prefaced empathic talk and particle(s)+so-prefaced empathic talk. The research findings could reveal the interactional details of empathy in psychotherapy and thus contributes to the understanding of the nature and process of psychotherapy and counselling.
Using Conversation Analytic (CA) methods, the present study attempts to analyze the various functions of face-based therapist empathy, and how they are sequentially realized in different psychotherapeutic settings. Four types of face-based therapeutic functions are discussed; more specifically, it is illustrated how therapist empathy may serve to maintain, enhance, threaten or even save the client’s face. The findings gained could contribute to a better understanding of the face-based therapeutic functions of empathy; also, the study may inspire researchers to further investigate other functions of therapist empathy in psychotherapy.
In conversational analysis, the meaning of an utterance‐in‐conversation is the hearing given to the utterance by the participants, as displayed in their responses. This orientation to participants is very clear in conversational analytic studies and quite consistent with an interactional approach. What is perhaps less clear is that there is another way, within the framework of conversational analysis, of arriving at interpretations of utterances. These latter interpretations are referred to here as “conversationally grounded analyst's interpretations,” and they may be quite distinct from participant hearings. An exchange during a family therapy session is examined in detail to illustrate the notion of an analyst's interpretation. Finally, the usefulness of such a concept in the analysis of conversation is discussed.
Conversations between AIDS counsellors and their clients bring delicate and potentially threatening issues into play. In this study Anssi Peräkylä applies the principles of conversation analysis to his exploration of AIDS counselling, using data from video-recorded counselling sessions in a London teaching hospital. He meticulously analyses this data to show how various questioning techniques, in this case arising from the Milan School Family Systems theory, operate in these situations, and how counsellors attempt through the design and placement of their questions to achieve the cooperation of their clients, with varying success. His conclusions provide a timely and illuminating insight into the management of a sensitive topic through various techniques of indirectness.
This paper illustrates the difference between absolute and social conceptions of responsibility, by employing the perspective of the sociology of knowledge. Comparing the degree of shared awareness and the organization of the format of the transaction in initial psychiatric and legal interviews, propositions showing the relationship between the power and authority of the interactants, and the resultant shared definition of the client's responsibility, are suggested. The implications of these points for psychiatric and legal policy, and for social science research are discussed in the conclusion.
Conversational practices related to talk about future in AIDS counselling are analysed in this paper. A particular type of questioning is examined, where the counsellor's description of a hypothetical future situation is followed by an enquiry focusing on the patient's fears or ways of coping in this particular situation. It is argued that a favorable conversational environment and management of the epistemological framework of the discourse are key factors facilitating the patients’ answers to such questions. The observations are tied with discussion about construction of ‘reality’ in conversation.