Person references, change in footing, and agency positioning in psychotherapeutic conversations.

This study contributes to the research on agency positioning in psychotherapy by looking at how clients and therapists, when discussing the client's difficulties, made use of two specific conversational practices, i.e., different grammatical forms of person reference and changes in footing, and what the consequences of this were for how the clients were positioned in relation to their problematic experiences. A data corpus of the first sessions of nine psychotherapies at a university training clinic in Finland was utilized. The uses of person references and changes in footing in therapists' initiative turns, clients' responses, and therapists' third position (recipient) actions were examined. The analysis showed that in initiative turns therapists usually used the second-person singular, as an invitation for the client to respond from his/her personal point of view, thus ascribing active agency to the client. When telling their problematic experiences, clients typically used so-called zero-person constructions, presenting such experiences as common to people in general, thus lessening their agency and inviting the therapist to share their experiential position. In recipient actions, therapists could use a combination of zero and active person reference which served to communicate an empathic stance and an invitation to the client to take an agentic observer position. Almost exclusively, only therapists used changes in footing. This could happen rapidly within single utterances and serve to express affiliation with the client's emotional experience and to invite or challenge the client to take an observer position. The study supplemented the CA change model with the DA and DSA notions of changes in agency positions as core elements in therapy talk and showed how variations in person references and changes in footing had a decisive influence on how different types of turns functioned within the overall conversational structure of the psychotherapy institution.

Assimilation, reflexivity, and therapist responsiveness in group psychotherapy for social phobia: A case study.

OBJECTIVE: This case study examined reflexivity and the assimilation of problematic experiences, especially its progress within and between the Assimilation of Problematic Experiences Scale (APES) Stages 2-3, in group psychotherapy for social phobia. METHOD: The data consisted of all of one client's turns expressing the two voices of her main problematic experience in 12 sessions, and all replies by the therapist in direct connection to them. The client's utterances were rated on the APES. RESULTS: A detailed analysis of 13 conversational passages revealed that progress in assimilation happened only when the client took a reflexive stance towards her inner experience or outer actions. There were a few instances when she took a reflexive stance, but no progress in assimilation could be noted. A qualitative analysis of three conversational episodes showed how therapist responsiveness facilitated the client's increased reflexivity and progress in assimilation. CONCLUSIONS: Reflexivity appears to be a necessary condition for progress in assimilation both at APES Stages 2 and 3, but the model should recognize that reflexivity can appear in diverse forms and at different levels. Therapist responsiveness and sensitivity to the client's assimilation process is crucial for a successful transition from Stage 2 to Stage 3.

Effects of training on attitudes of psychiatric personnel towards patients who self-injure.

BACKGROUND: Improving attitudes of personnel towards self-injurious patients leads to better working alliance and contributes to better patient outcomes. Previous research into the improvement of these attitudes has recorded the need for specific training in evidence-based assessment and treatment of self-injurious patients. AIM: The current study describes the attitudes towards self-injurious patients among psychiatric personnel. The study also evaluates the effect of a structured clinical training program on psychiatric personnel's attitudes towards patients who self-injure. It further examines whether age, education, frequency of self-injurious patients contact, and work experience of the personnel are associated with the existing attitudes. METHODS: Psychiatric personnel (N = 50) attended a four-day training program, presenting evidence-based knowledge regarding self-injury assessment and treatment, using group exercises and reflective learning principles. The personnel completed the Understanding Suicidal Patients Questionnaire (USP) anonymously PreTraining, on 17 January 2014, and PostTraining, on 20 June 2014. The mean differences as well as single USP items before and after the training were tested by unpaired t-test. Two-way ANOVA was used to test impact of background variables on the USP scores. RESULTS: The training program had statistically significant impact (P < 0·01) on the following individual items of the USP scale: Patients who have tried to commit suicide are usually treated well in my work unit (d = 1·02); A person who has made several suicide attempt is at greater risk of committing suicide (d = 0·64); Because the patients who have tried to commit suicide have emotional problems, they need the best possible treatment (d = 0·57). The results also suggested that the frequency of patient contact had impact on attitudes towards self-injurious patients.

Constructing and negotiating 'change' in follow-up meetings for intimately violent men.

This study reports on follow-up meetings of a group treatment program for intimately violent men. The focus is on the construction of change narratives; on how indicators of 'successful change' are negotiated and produced in the conversations. We describe in detail five discursive strategies used by client and therapist participants, e.g., the construction of temporal differences, personalizing the problem, reformulations of failure stories, taking presence at the follow-up as evidence of success, and the use of out-siders as an audience. We also demonstrate how the notion of success is ascertained and to whom credit is given for achieving it. We conclude that the followup meetings are established as an integrated part of the whole treatment program, and contribute to the promotion of the treatment ideology.

Interactional positions and the production of identities: negotiating fatherhood in family therapy talk.

Participants in a conversation may, even within the same basic role staging create different cooperation settings. To describe these cooperative settings, we employ the concept of interactional position as a basic analytical tool. From our understanding of identity as a conversational achievement, we demonstrate how evolving interactional positions frame the construction of client identities in family therapy meetings. We focus particularly on how constructions of fatherhood identity are negotiated in the meetings. The methodological perspective of our study draws on social psychological discourse analysis, conversation analysis and social constructionism, and the data consists of video recordings of six family therapy meetings dealing with a single case. The analysis demonstrates the large variety of combinations of interactional positions that are possible in family therapy conversation and explicates how strongly the construction of the client's identity depends on the position combinations allowed in a therapy session.

Loss of self-control as excuse in group-therapy conversations for intimately violent men.

This article examines the constructions of loss of self-control by male perpetrators of intimate violence in therapy-group conversations. It looks at discursive strategies used by therapists and clients in therapy-group negotiations concerning the issue of self-control. The data are part of a larger corpus of videotaped and transcribed recordings of treatment groups for male perpetrators and consists of four treatment group processes. The analysis concentrates on episodes of self-control talk where a participant referred to loss of self-control when accounting for his violent behavior. The loss of self-control was found to be a fundamental constituent of excuses and was used to account for the clients' behavior in past violent situations. It allowed the speaker to admit the reprehensible character of his behavior, while denying full responsibility for it. It also permitted the speaker to be portrayed as a responsible person in the present conversational group therapy context. These different representations of the past and present selves gave those presentations the appearance of inconsistency. The therapists used this inconsistency in the clients' talk to challenge the use of loss of self-control as excuse, and thus called for more responsible accounts.