Studies of the psychotherapeutic process using the methods of conversation analysis can make a substantial contribution to further development of psychotherapeutic practice. The case study of Amalia, particularly session 152, has been analysed many times using different methods that are briefly reviewed here. This paper is devoted to the analysis of session 152, based on the new transcription material that includes the prosodic elements of the dialogue in the analytical dyad. Our study demonstrates the following: (a) how the analyst and the patient together create a common object of conversation, i.e. psychoanalysis; (b) the use of different therapeutic tools that have not been properly covered in literature yet and may be described as ‘devices’. We define our work as a qualitative study based on the non-statistical data of the verbal production analysis whose results may be used for advancing new hypotheses.

We present the results of further analys of 152nd sessions of the exemplary case of Amalia. We apply the methods of conversation analysis and the analysis of metaphors to the script of the audio record using the new system of transcription that reflects prosodic elements of dialogue in the analytic dyad. In this part of our study one can “see” a) a “dance of insight” of the patient and the analyst, which reveals the pattern of interaction between two positions; b) the creation of metaphors by the participants of the analytic dyad, which are then used as cognitive tools and means of communication that allows among other things to reflect the extraordinary complexity of the analytic interaction in a condensed way. In addition, we show the relevance of the threefold model of analytic conversation for the generalized descriptions of prosodic rhythmicity and other prosodic characteristics. This model consists of the following components: “interaction engine”, “talking to” and “talking about”.

The results of the present study give evidence of the importance of taking into consideration the expectations of the patients suffering from the consequences of a psychological trauma as regards the results of psychotherapy as well as the mode of their personal interactions with the attending physicians which in its turn depend on the specific dynamics features of the disease and its overall clinical picture. In order to maintain a 'working alliance' between the patient of the given group and the psychotherapist, the latter should follow a certain pattern of interpersonal relationships with the patient which can be described by octants 2, 4-7 of the Interpersonal Relationship Diagnostics questionnaire. Also, the results obtained in the study can be used for the elaboration and implementation of the comprehensive psychotherapeutic and rehabilitative programs within the framework of health resort-based treatment programs for the employees of hazardous occupations who experience problems arising from the consequences of psychic trauma.

According to four-factor model of therapeutic change developed by Lambert (1992) patient's expectations towards psychotherapy is one of the most influential important factors which attributed 15% to change process. In this research we studied patients' expectations in psychotherapy among different samples in Russia. We present the results of the four-fold research program: (1) translation and adaptation of the Psychotherapy Expectations and Experiences Questionnaire, PEX-P1, by Clinton and Sandel; (2) study of patients' expectations among those who suffer sequela of psychic trauma; (3) study of patients' expectations among patients of psychiatric clinic with anxiety, affective, and somatoform disorders; and (4) study of patients' expectations among clients of counseling centers. The results showed good psychometric qualities of the Russian version PEX-P1. We tested the hypothesis of a correlation between the degree of manifestation of psychological trauma and PTSD symptoms on the one hand and patients expectations with regard to psychotherapy on the other among those who had faced potentially psycho-traumatized situations (n=279). The next part of the study program has been performed on patients of psychological services centers (n=19). It was a pilot study, to be followed by research on larger samples. The methods included the PEX-P1, the Method of the Interpersonal Diagnosis of Personality by T. Leary, SCL-90-R, STAI, and NEO-FFI. The Leary method was used to examine the patients' expectations with regard to the therapist's personality and was administered twice with the same respondent. Patients' average expectations for "good" therapists are around the adaptive values (0 to 4 points).

One of the most important factors, influencing the development on concept of confidence in psychotherapy is social environment. The analysis of expectations of Russian patients towards psychotherapy (this construct with a certain limitations can be assimilated to concept of confidence in psychotherapy) requires taking into account social environment factor, including social-demographic situation in the Russian Federation. According to the results of a survey of the Public Opinion Foundation (POF) including 1500 individuals aged 18+ years (dated November 2014), the use of psychotherapeutic and psychological services decreased since 2006 by 20% (!) and today constitutes less than 20%. According to participant’s opinion, the accessibility of psychotherapeutic service slightly increased (by 5%). During the same time period the number of respondents who are certain that reference to psychologists or psychotherapists is worthless increased by 8%. At the same time, according to national statistical investigations, more than 30% of population has psychiatric conditions requiring medical help or consultation of a psychiatrist, or, more often, a psychotherapist or clinical psychologist. Consequently, there is a decrease of confidence in psychotherapy among potential service consumers in our country, which is to no small degree associated with concern of disapproval of psychotherapeutic help by reference group (friends, colleagues, family members etc.). In other words, psychotherapeutic or psychological help will be associated with shame and insecurity. The reason for such an attitude of population to psychotherapeutic treatment are likely distorted perception, associated with lack of information, apprehensive attitude towards psychiatric treatment (which is closely related in the public consciousness to psychotherapy). The attitude of internists and health officials towards psychotherapy may play an important role in the discrediting psychotherapy. One gets the impression that nowadays at the present stage of development of psychotherapy in our country, educational function of psychotherapist becomes of paramount significance. It should be aimed both at the development of knowledge on the efficacy of psychotherapeutic methods and at the necessity of engagement of psychotherapists and psychologists in diagnostics and treatment alongside with internal medicine doctors, and also at the promotion of credibility of psychotherapy among the potential users of psychotherapeutic services.