First Encounters in Psychotherapy: Relationship-Building and the Pursuit of Institutional Goals

Abstract

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time.

Doing-together with words: the sequential unfolding of a moment of meeting in a psychoanalytic therapy session

“…Therefore, it is a convenient method for analyzing the relational aspect of the psychotherapeutic process as manifested in client–therapist exchanges. For instance, the client–therapist relationship has been investigated from an interactionist perspective using CA to analyze the interaction between therapist and client ( Scarvaglieri, 2020 ).…”

“…Regarding the transformation of relation, Peräkylä states that psychotherapeutic encounters document, reproduce, and renew (moment by moment) the particular socioemotional relation between that particular therapist and that particular client. CA research on this topic includes key relational phenomena like agreement and disagreement or resistance , affiliation and disaffiliation , and the epistemic relation between participants ( Voutilainen et al, 2010 ; Muntigl et al, 2012 ; Scarvaglieri, 2020 ; Guxholli et al, 2021 ): “These and other aspects of the momentary relation get transformed through sequentially organized actions.” ( Peräkylä, 2019 , p. 271).…”

Editorial: Innovative studies in organized helping: transforming relations, emotions and referents through sequentially structured practices

“…Labov, 1972) and show that therapists can use patients' orientation to the recording situation to initiate and support patients' self-exploration and to support change (cf. Pawelczyk and Graf, 2019;Scarvaglieri, 2020). Tauroginski et al worked with data from psychoanalytic couples therapy and focused on complaints, which in this setting is a frequently recurring activity.…”

Sprechen und Schweigen in der Psychotherapie

“…1, S. 209). Die Unverzichtbarkeit kultureller Reserven für die Deutung in der Sitzung wurde durch KA-Studien belegt (Scarvaglieri 2020). Deutungen stellen Zusammenhänge zwischen Erfahrungsbereichen her (Peräkylä 2004, S. 293).…”