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The therapist’s emotional presence and its interactional functions in promoting client change in relationship-focused integrative psychotherapy

Issue: Vol 16 No. 2 (2019) Special Issue: Understanding Change in Psychotherapy

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.33823


Therapeutic alliance is often posed as an explanation for why therapy works, and there seems to be a consistent finding that the stronger the alliance, the greater the therapeutic change. Although extensively documented in the professional literature as an essential aspect of therapeutic alliance, the concept of emotional presence and its actualization in moment-by-moment interaction have not been adequately described. This paper applies integrative qualitative methodology, including tools and insights from discourse analysis and conversation analysis, to five extracts of Relationship-focused Integrative Psychotherapy sessions with three different clients. It examines the concept of emotional presence operationalized in terms of the therapist’s invoking the client’s immediate experience. The analytical focus falls on an interactive sequence involving the therapist’s topicalization of the client’s (proffered) non-verbal cues aiming at eliciting emotion talk in the interactional here-and-now and the latter’s orientation to it. The psychotherapist’s strategy of emotional presence is proposed to play a salient role in promoting the client’s (gradual) change by focusing the talk on the client’s here-and-now experience. Thus clients are prompted to project their emotions and/or engage in overt self-reflexive examination of emotional and relational patterns in the immediate context of their concrete trouble-telling. By being regularly exposed to such practices in therapy, clients are instilled with a sense of being in touch with how they feel about a particular situation or person.

Author: Joanna Pawelczyk

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References :

Angus, Lynne, Tali Boritz, Emily Bryntwick, Naomi Carpenter, Chistianne Macaulay and Jasmine Khattra (2017) The narrative-emotion process coding system 2.0: A multi-methodological approach to identifying and assessing narrative-emotion process markers in psych­otherapy. Psychotherapy Research 27 (3): 253–269.

Antaki, Charles (2008) Formulations in psych­otherapy. In Anssi Peräkylä, Charles Antaki, Sanna Vehvilainen and Ivan Leudar (eds) Conversation Analysis and Psychotherapy, 26–42. Cambridge: Cambridge University Press.

Antaki, Charles, Rebecca Barnes and Ivan Leudar (2005) Self-disclosure as a situated inter­actional practice. British Journal of Social Psychology 44 (2): 181–199.

Atkinson, J. Maxwell and Paul Drew (1979) Order in Court: The Organization of Verbal Interaction in Judicial Settings. London: Macmillan.

Avdi, Evrinomy (2012) Exploring the contribution of subject positioning to studying therapy as a dialogical enterprise. International Journal for Dialogical Science 6 (1): 61–79.

Bercelli, Fabrizio, Federico Rossano and Murizio Viaro (2008) Clients’ responses to therapists’ re-interpretations. In Anssi Peräkylä, Charles Antaki and Sanna Vehviläinen (eds) Conversation Analysis and Psychotherapy, 43–62. Cambridge: Cambridge University Press.

Bordin, Edward S. (1979) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice 16 (3): 252–260.

Bugental, James F. T. (1987) The Art of the Psych­otherapist. New York: W. W. Norton.

Carey, Timothy, Margaret Carey, Kirsten Stalker, Richard J. Mullan, Lindsey Murray and Margaret B. Spratt (2007) Psychological change from the inside looking out: A qualitative investigation. Counselling and Psychotherapy Research 7 (3): 178–187.

Davis, Kathy (1986) The process of problem (re) formulation in psychotherapy. Sociology of Health and Illness 8 (1): 44–74.

Drew, Paul and John Heritage (1992) Talk at Work: Interaction in Institutional Settings. Cambridge: Cambridge University Press.

Elliott, Richard (2010) Psychotherapy change process research: Realizing the promise. Psychotherapy Research 20 (2): 123–135.

Gale, Jerry E. (1991) Conversation Analysis of Thera­peutic Discourse: The Pursuit of a Therapeutic Agenda. Norwood, NJ: Ablex.

Geller, Shari M. and Leslie S. Greenberg (2002) Therapeutic presence: Therapists’ experience of presence in the psychotherapy encounter. Person-Centered and Experiential Therapies 1 (1–2): 71–86.

Goodwin, Charles (1994) Professional vision. American Anthropologist 96 (3): 606–633.

Hak, Tony and Fijgje de Boer (1996) Formulations in first encounters. Journal of Pragmatics 25 (1): 83–99.

Heritage, John (2013) Epistemics in conversation. In Jack Sidnell and Tanya Stivers (eds) The Handbook of Conversation Analysis, 370–394. Oxford: Wiley-Blackwell

Heritage, John and J. Maxwell Atkinson (1984) Introduction. In J. Maxwell Atkinson and John Heritage (eds) Structures of Social Action, 1–15. Cambridge: Cambridge University Press.

Heritage, John and Rod Watson (1979) Formulations as conversational objects. In George Psathas (ed.) Everyday Language, 123–162. Mahwah, NJ: Lawrence Erlbaum.

Higginson, Sally and Warren Mansell (2008) What is the mechanism of psychological change? A qualitative analysis of six individuals who experi­enced personal change and recovery. Psychology and Psychotherapy 81 (3): 309–328.

Hill, Clara E. and Sarah Knox (2009) Processing the therapeutic relationship. Psychotherapy Research 19 (1): 13–29.

Horvath, Adam and Robinder P. Bedi (2002) The alliance. In John C. Norcross (ed.) Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients, 37–70. New York: Oxford University Press.

Hutchby, Ian (2005) Active listening: Formulations and the elicitation of feelings-talk in child counseling. Research on Language and Social Interaction 38 (3): 303–329.

Hutchby, Ian (2007) The Discourse of Child Counselling. Amsterdam: John Benjamins.

Jefferson, Gail (2004) Glossary of transcript symbols with an introduction. In Gene H. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–23. Amsterdam: John Benjamins.

Keselman, Henrich, Karin Osvaldsson Cromdal, Niclas Kullgrad and Rolf Holmqvist (2016) Responding to mentalization invitations in psychotherapy sessions: A conversation analysis approach. Psychotherapy Research 28 (4): 654–666.

Kondratyuk, Nataliya and Anssi Peräkylä (2011) Therapeutic work with the present moment: A comparative conversation analysis of existential and cognitive therapies. Psychotherapy Research 21 (3): 316–330.

Leiman, Mikael (2012) Dialogical sequence analysis in studying psychotherapeutic discourse. Inter­national Journal for Dialogical Science 6 (1): 123–147.

Levitt, Heidi, Mike Butler and Travis Hill (2006) What clients find helpful in psychotherapy: Dev­eloping principles for facilitating moment-to-moment change. Journal of Counseling Psychology 53 (3): 314–324.

Maynard, Douglas W. and Don H. Zimmerman (1984) Topical talk, ritual and the social organization of relationships. Social Psychology Quarterly 47 (4): 301–316.

McVittie, Chris, Slavka Craig and Margaret Temple (2019) A conversation analysis of communicative changes in a time-limited psychotherapy group for mothers with postnatal depression. Psychotherapy Research. Online first.

Moursund, Janet and Richard Erskine (2004) Integrative Psychotherapy: The Art and Science of Relationship. Belmont, CA: Wadsworth.

Muntigl, Peter (2013) Resistance in couples counsel­ing: Sequences of talk that disrupt progressivity and promote disaffiliation. Journal of Pragmatics 49 (1): 18–37.

Muntigl, Peter and Adam Horvath (2005) Lan­guage, psychotherapy and client change: An interdisciplinary perspective. In Ruth Wodak and Paul Chilton (eds) A New Agenda in (Critical) Discourse Analysis, 213–239. Amsterdam: John Benjamins.

Muntigl, Peter and Adam Horvath (2014a) ‘I can see some sadness in your eyes’: When experiential therapists notice a client’s affectual display. Research on Language and Social Interaction 47 (2): 89–108.

Muntigl, Peter and Adam Horvath (2014b) The therapeutic relationship in action: How therapists and clients co-manage relational disaffiliation. Psychotherapy Research 24 (3): 327–345.

Norcross, John C. (ed) (2002) Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. New York: Oxford University Press.

Norcross, John C. (ed) (2011) Psychotherapy Rela­tion­ships that Work: Evidence-Based Resp­onsive­ness (2nd edition). New York: Oxford University Press.

Pawelczyk, Joanna (2011) Talk as Therapy: Psych­otherapy in a Linguistic Perspective. Berlin: Mouton de Gruyter.

Pawelczyk, Joanna and Richard Erskine (2008) Expressing the unexpressed: Self-disclosure as interactional achievement in the psychotherapy session. Communication & Medicine 5 (1): 39–48.

Peräkylä, Anssi (2004) Making links in psycho­analytic interpretations: A conversation analytic view. Psychotherapy Research 14 (3): 289–307.

Peräkylä, Anssi (2013) Conversation analysis in psychotherapy. In Jack Sidnell and Tanya Stivers (eds) The Handbook of Conversation Analysis, 551–574. Oxford: Wiley-Blackwell

Peräkylä, Anssi (2019) Conversation analysis and psychotherapy: Identifying transformative sequences. Research on Language and Social Interaction 52 (3): 257–280.

Peräkylä, Anssi and Sanna Vehviläinen (2003) Conversation analysis and the professional stocks of interactional knowledge. Discourse & Society 14 (6): 727–750.

Pomerantz, Anita (1980) Telling my side: ‘Limited access’ as a fishing device. Sociological Inquiry 50 (3–4): 186–198.

Pomerantz, Anita (1986) Extreme case formula­tions: A way of legitimizing claims. Human Studies 9 (2–3): 219–229.

Pomerantz, Anita and Jenny Mandelbaum (2005) Conversation analytic approaches to the relevance and uses of relationship categories in interaction. In Kristine L. Fitch and Robert F. Sanders (eds) Handbook of Language and Social Interaction, 149–171. Mahwah, NJ: Lawrence Erlbaum.

Rennie, David L. (1992) Qualitative analysis of the client’s experience of psychotherapy: The unfolding of reflexivity. In Shaké G. Toukmanian and David L. Rennie (eds) Psychotherapy Process Research: Paradigmatic and Narrative Approaches, 211–233. Newbury Park, CA: Sage.

Rice, Laura and Leslie Greenberg (1984) Patterns of Change: Intensive Analysis of Psychotherapy Process. New York: Guilford.

Sacks, Harvey (1984) On doing ‘being ordinary’. In J. Maxwell Atkinson and John Heritage (eds) Structures of Social Action: Studies in Conversation Analysis, 413–429. Cambridge: Cambridge University Press.

Safran, Jeremy D. and John C. Muran (2006) Has the concept of the alliance outlived its usefulness? Psychotherapy 43 (3): 286–291.

Stern, Daniel (2004) The Present Moment in Psych­otherapy and Everyday Life. New York: W. W. Norton.

Strong, Tom (2003) Engaging reflection: A training exercise using conversation and discourse analysis. Counselor Education and Supervision 43 (1): 65–77.

Strong, Tom and Olga Smoliak (2018) Introduction to discursive research and discursive therapies. In Tom Strong and Olga Smoliak (eds) Therapy as Discourse: Practice and Research, 71–93. Basingstoke, UK: Palgrave Macmillan.

Vehviläinen, Sanna (2008) Identifying and managing resistance in psychoanalytic interaction. In Anssi Peräkylä, Charles Antaki and Sanna Vehviläinen (eds) Conversation Analysis and Psychotherapy, 120–138. Cambridge: Cambridge University Press.

Viklund, Erika, Rolf Holmqvist and Karin Nelson-Zetterqvist (2010) Client-identified important events in psychotherapy: Interactional structures and practices. Psychotherapy Research 20 (2): 151–164.

Voutilainen, Liisa and Anssi Peräkylä (2014) Thera­peutic conversation. In Jan-Ola Östmann and Jef Verschueren (eds) Handbook of Prag­matics. Amsterdam: John Benjamins.

Voutilainen, Liisa, Anssi Peräkylä and Johanna Ruusuvuori (2011) Therapeutic change in inter­action: Conversation analysis of a trans­forming sequence. Psychotherapy Research 21 (3): 348–365.

Voutilainen, Liisa, Federico Rossano and Anssi Peräkylä (2018) Conversation analysis and psych­otherapeutic change. In Simona Pekarek Doehler, Johannes Wagner and Esther González-Martínez (eds) Longitudinal Studies on the Organization of Social Interaction, 225–254. Basingstoke, UK: Palgrave Macmillan.

Wampold, Bruce E. (2001) The Great Psychotherapy Debate: Models, Methods and Findings. Mahwah, NJ: Lawrence Erlbaum.

Watson, Jeanne C., Leslie S. Greenberg and Germain Lieater (1998) The experiential paradigm unfolding: Relationship and experiencing in therapy. In Leslie S. Greenberg, Jeanne C. Watson and Germaine Lieater (eds) Handbook of Experi­ential Psychotherapy, 3–27. New York: Guilford.

Weiste, Elena and Anssi Peräkylä (2013) A comparative conversation analytic study of formulations in psychoanalysis and cognitive psychotherapy. Research on Language and Social Interaction 46 (4): 299–321.