Electrodermal and respiratory synchrony in couple therapy in distinct therapeutic subsystems and reflection periods.

Objective Synchrony in the multi-person context of systemic therapy is a complex and understudied phenomenon. We analyzed respiratory and electrodermal synchronies within a couple therapy system with two therapists to determine whether dyadic subsystems between each client and therapist synchronized differently. We also studied synchrony in reflection periods, in which the therapists discussed the therapy process with clients listening. Finally, we examined the association of synchronies with alliance and outcome.Method: A sample of 22 therapy sessions in which electrodermal activity (EDA) and respiration were recorded were analyzed. Self-report measures of session alliance and outcome were obtained. Synchrony computation was based on windowed cross-correlation using surrogate synchrony and segment-wise shuffling of physiological time series.Results: The results supported the presence of EDA synchrony for the client-therapist and therapist-therapist dyads but not client-client dyads across entire sessions. No significant synchronies were found for respiration behavior. A similar picture was found in reflection periods. Clients' well-being as well as therapists' alliance ratings were significant predictors of client-client EDA synchrony.Conclusion: Our results point to the relational meaning of synchrony and its importance for understanding couple psychotherapy, particularly the reflection periods. Challenges involved in extending synchrony computation to multi-person settings were highlighted.

Epistemic asymmetries in psychotherapy interaction: therapists' practices for displaying access to clients' inner experiences.

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 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client's inner experience. In the formulations, the therapists and clients co-described the client's experience, demonstrating that the client's inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client's talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client's inner experience was called into question.

Prosody and empathic communication in psychotherapy interaction.

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 difference between these trajectories was not evident in the lexical composition of the therapists' formulations that initiated the trajectory. However, the prosodic features of the formulation already anticipated the direction of the trajectory. The formulations leading up to the validating trajectory were characterized by prosodic continuity and formulations leading up to the challenging trajectory by prosodic disjuncture. The choice between continuous and disjunctive prosody was a key resource for therapists in the construction of formulations as either validating or challenging. CONCLUSIONS: The present article emphasizes the relational aspects of psychotherapy communication by considering the prosodic features of the therapist's talk in relation to the prosody of the client.

Conversation analysis of the two-chair self-soothing task in emotion-focused therapy.

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: Conversation analysis was used to examine client-therapst interaction. RESULTS: The analysis yielded a detailed description of interactional practices and processes involved in the accomplishment of self-soothing, drawing on Goffman's concept of the participation frame. We show how therapists and clients collaborate to move from the ordinary frame of therapeutic conversation to a self-soothing frame and back again by using various interactional practices: Therapists' instructions to clients, specific ways of sequencing actions in interaction, explanations and justification of the importance of the self-soothing task, pronouns as a way to distinguish among addressees (e.g., clients versus soothing agents), corrections of clients' talk, and response tokens (hm mm, yeah, good). These practices are used to help clients accomplish self-soothing in the form of self-praise, disclosing caring, and offering of helpful advice. CONCLUSIONS: This study offers therapists a specific account of how to respond to clients at specific junctures in self-soothing dialogues and how to structure and accomplish the self-soothing task.

What to take up from the patient's talk? The clinician's responses to the patient's self-disclosure of their subjective experience in the psychiatric intake interview.

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 adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an expert interpretation of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.

Shame in social interaction: Descriptions of experiences of shame by participants with high or low levels of narcissistic traits.

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 ashamed of themselves. We found the narratives to vary in terms of five dimensions. With narcissistic individuals, the default narrative tended to exhibit a cluster of characteristics that gather at one end of these dimensions: (1) weak expressions of shame; (2) located in the story-world; (3) low level of reflexivity as well as; (4) responsibility of the described event; and (5) a general level of description. We discuss the findings in relation to sociological and psychological theories of shame and suggest that individuals with narcissistic personality traits are more inclined to use suppressive conversational practices in their treatment of shame, thus providing a "window" to these interactional practices.

Putting self at stake by telling a story: Storyteller's narcissistic traits modulate physiological emotional reactions to recipient's disengagement.

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 disengagement.Building on Bavelas, Coates, and Johnson [1] we conducted a conversational experiment instructing the participants to tell about a "close call" experience to a previously unknown co-participant. We modified the co-participant's level of interactional engagement by asking them either to listen to the story carefully or to simultaneously carry out a counting task that distracted them from the content of the story. We found that the distraction condition was unrelated to the storytellers' narration performance, but a significant positive association was found between the story-recipients' observed lack of affiliation and the tellers' narration performance. The distraction of recipients was also associated with increased self-reported arousal in the tellers, indicating disengagement-induced stress in the tellers. Moreover, tellers higher in grandiose narcissism reacted with higher skin conductance response to disengagement, and vulnerable narcissism was associated with higher heart rate during narration in general. Our experiment thus showed that grandiose narcissists are emotionally sensitive to their co-participants' disengagement.

'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders.

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 generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.

Spectrum of complaints: practices of complaining in therapeutic conversations as a window to spouses' personalities and couples' relationships.

Introduction: Complaining is a frequent phenomenon in human interactions and it frequently happens during couple counseling. A conversation between a therapist and spouses that requires them to talk about problems inevitably leads to complaining (especially during the first meeting). The institutional context and the presence of an impartial therapist shape the complaining sequences. Method: We used conversation analysis to explore the interactional organization of complaining in the specific context, which is couples therapy. Our data involve video recordings of nine couple therapy first consultations. Results: In the results section of our paper, we describe in detail the composition and delivery of complaints in couple therapy setting. Our observations made it possible to propose a nuanced spectrum of ways of complaining that spans the considerateness dimension. Our data suggest that there may be a relationship between the manner of complaining and the presence and severity of maladaptive personality traits of complainers. Discussion: We argue that paying close attention to complaining practices that arise during couple therapy is an important aspect of clinical work with couples and can be informative regarding the nature of spouses' quarrels and their personality constitutions.

Grandiosity, vulnerability, and narcissistic fluctuation: Examining reliability, measurement invariance, and construct validity of four brief narcissism measures.

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), Hypersensitive Narcissism Scale (HSNS), Super-Brief Pathological Narcissism Inventory (SB-PNI), and the g-FLUX] in a Finnish sample of university students. Confirmatory factor analyses supported the reliability of the NPI-13, g-FLUX, SB-PNI Vulnerability, and two HSNS subfactors (Oversensitivity and Egocentrism). Tests of measurement invariance indicated the NPI-13, SB-PNI Vulnerability, HSNS Oversensitivity, and the g-FLUX perform similarly between males and females and are generally similar between individuals in younger and older age groups. Construct and predictive validity were evaluated by examining relations between narcissism measures and relevant criteria including psychopathology symptoms, self-esteem, well-being, five factor traits, and empathy. Results supported the construct validity of all four measures, while correlational profiles highlighted the convergence between the g-FLUX and measures of both grandiosity and vulnerability. The NPI-13 was most predictive of NPD symptoms, whereas vulnerable narcissism measures were most predictive of psychopathology. Results further establish the psychometric properties of the NPI-13, SB-PNI Vulnerability, HSNS Oversensitivity, Egocentrism, and provide new validation of the g-FLUX.

Therapeutic work with the present moment: a comparative conversation analysis of existential and cognitive therapies.

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 compared with a therapist's corresponding action in cognitive therapy. The study contributes to the description of interactional practice of existential therapy, and involves the first application of conversation analysis to a comparative study of psychotherapy process. The potential utility of this approach and the clinical and empirical implications of the present findings are discussed.

Therapeutic change in interaction: conversation analysis of a transforming sequence.

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's tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient's responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client's talk.

How couple therapists manage asymmetries of interaction in first consultations.

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 asymmetry, are described in detail. Asymmetries of affiliation regularly co-occur with the exclusion of 1 spouse from the interaction. Asymmetries of affiliation and participation can be addressed by 2 types of action by the therapist: (a) In counterbalancing moves, the therapist shifts their affiliation back to the spouse that was neglected. (b) In systemic couple-directed interventions, the therapist creates symmetry of affiliation and participation not only by attending to the individual spouses but also by addressing the couple as a single social unit. The observations are discussed in the light of the concept of split alliance and alliance ruptures, as well as in the context of research into affiliation as a generic property of social interaction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Patients' Practises Disclosing Subjective Experiences in the Psychiatric Intake Interview.

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 conversation analysis, we examined such sequences in diagnostic interviews in an outpatient clinic in Finland. From 10 audio-recorded diagnostic interviews, we found 45 segments where medical questions were met with patients' self-disclosures. We show four sequential trajectories that enable this shift of topic and action. There are four possible trajectories: (1) the patient first answers the medical question and the clinician acknowledges this answer, whereupon the patient shifts to a self-disclosure of their subjective experience; (2) the patient first gives the medical answer but shifts to self-disclosure without the clinician's acknowledgement of that answer; (3) the patient produces an extensive answer to the medical question and, in the course of producing this, shifts into the self-disclosure; (4) the patient does not offer a medical answer but designs the self-disclosure as if it were the answer to the medical question. We argue that in the shifts to the self-disclosure of their subjective negative experience, the patients take local control of the interaction. These shifts also embody a clash between the interactional projects of the participants. At the end of the paper, we discuss the clinical relevance of our results regarding the patient's agency and the goals of the psychiatric assessment.

Professional non-neutrality: criticising the third party in psychotherapy.

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 as a tool for achieving institutional goals. The analysis focuses on the psychotherapist's actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist's further actions that challenge the patient's dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.

Practices of joint meaning creation. Dreams in psychoanalytic discussion.

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 analyst or the patient asserts the meaning of a dream element, for example stating that the cow in the dream means women. (2) In meaning creation through redescription, the analyst describes anew events belonging to the real world or the dream, which have been referred to in the earlier conversation. This redescription makes possible the subsequent assertion of explicit linkages between the dream and the real world. (3) In the merging of referential worlds, the analyst extends the patient's real-world description with images that are recognisably from the dream: the world of the dream and the real world are thus momentarily merged. In discussion, we point out that in our audio recorded data, the dream interpretation does not primarily involve revealing repressed and unconscious ideas, but rather it involves reminding the patient of something that the patient already knows but is reluctant to think or talk about.

Safeguarding the Therapeutic Alliance: Managing Disaffiliation in the Course of Work With Psychotherapeutic Projects.

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 psychotherapeutic project at hand. Data come from a total of 18 sessions of two dyads undergoing psychoanalytic psychotherapy and is analyzed with conversation analysis. We found that collaborative moves deployed amidst enduring disagreement can assist the therapist in furthering the disagreement as part of the ongoing psychotherapeutic project. Relying on their collaborative format, therapists utilize collaborative moves to temporarily mend the disaffiliation without necessarily changing their position and re-affiliating with the patient. We show how the relation between the therapist and the patient gets transformed in the moment-by-moment work accomplished in the psychotherapeutic talk.

Practices of Claiming Control and Independence in Couple Therapy With Narcissism.

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 therapist's question, block or dominate the development of the conversation's topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by threats that the first couple therapy consultation imposes upon the clients' self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices.

Offering patients opportunities to reveal their subjective experiences in psychiatric assessment interviews.

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 to reveal their subjective experiences. METHODS: Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA). RESULTS: The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters. CONCLUSION: Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk. PRACTICE IMPLICATIONS: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.