Guest Speaker: Anssi Peräkylä
PSYCHOTHERAPY, PSYCHIATRY AND EMOTIONS
In the plenary presentations, I will be presenting conversation analytical studies on psychotherapy (presentation 1) and studies on emotion in interaction using combinations of conversation analytical and experimental methods (presentation 2). The data to be explored in the data session involves psychiatric intake interview.
The first presentation will lay out an overall view of conversation analytic (CA) study on psychotherapy. In a sociological perspective, psychotherapy is to be understood as a particular form of institutional interaction. The key characteristic of psychotherapy as institutional interaction arises from its particular inferential frameworks (see Drew and Heritage 1992: 21-25): the clients’ talk is understood beyond the speaker’s intended meaning, as indication of the particular (usually dysfunctional) ways of working of the patient’s mind (Peräkylä 2013). The goal of psychotherapy, accordingly, is to transform these ways of working of the mind in the client. In achieving that goal, psychotherapy is organized around sequences of actions, which can be characterized as being initiatory, responsive, or “third position” actions. CA studies have mostly focused on therapist’s actions, such as questions, formulations and interpretations. I will be arguing that through the sequences of actions, three transformation processes take place: the transformation of referents, emotions, and momentary relations between the participants. I will argue that these are key processes in enhancing therapeutic change in the patient. Key challenges for CA studies on psychotherapy will be discussed. One of them involves study designs that encompass long term processes extending the boundaries of single session. Another key challenge involves the understanding of interaction patterns pertaining to specific psychic disorders (such as depression, anxiety, or personality disorder). Finally, the contribution of CA on psychotherapy to CA studies on institutional interaction more generally will be discussed: particularly, I will argue that CA of psychotherapy highlights the importance of management of referents and the processes that go beyond single sequences and encounters, as targets of CA analysis.
The second presentation will give an overview of a string of studies on emotions in interaction using CA and experimental methods. In studies on facial expression, we have been exploring how facial expressions are coordinated with the initiation and completion of turns at talk, doing work to initiate, enhance or transform the emotional stances that are being conveyed by the speakers. In studies on emotion in psychotherapy, we have explored the different combinations of empathy and challenge in therapists’ responses to patients’ emotional expressions and narratives. For example, prosodic matching and mismatching between the patient’s and the therapist’s talk anticipatorily conveys either empathy or challenge by the therapist, in relation to the patient’s emotion descriptions. In a set of experimental studies, we have explored the ways in which the expressed stance of stories, and the affiliation displayed by the story recipients, are linked to the autonomous nervous system responses in the participants. These studies have uncovered linkages between the “interaction order”, and the physiological processes in the participants, thus elaborating Goffmanian view of interaction.
The data session will focus on psychiatric assessment interviews in an outpatient clinic. The data are in Finnish. The goal of psychiatric assessment is to define the patient’s diagnosis and treatment plan. In discussing diagnosis, the roles of the clinician and the patient seem to be different from what they are in somatic medicine: in the psychiatric assessment, the clinician seems to encourage and solicit patient participation in discussion on diagnosis, in ways that are rather rare in somatic medicine.