Life stories used as evidence for the diagnosis of addiction in group therapy

Abstract

In this article I study how the life stories of patients are used as evidence in the diagnosis of addiction in Minnesota model group therapy. As part of this therapy, patients have to tell their life story, concentrating on their substance abuse. This story is used by the therapists as a means for getting patients to recognize and accept that they are addicts. For this purpose the therapists use intervening questions. This article concentrates on the placement and the structure of the patients’ responses to these interventions and the kinds of attitudes or standpoints the patients express. I will also discuss ways in which the theory of the Minnesota model informs the therapists’ actions by analysing the places within the patient's story where the therapists choose to intervene and the structure of their intervening turns. The data of the study consist of five 45-minute group therapy sessions and three multi-professional team meetings in a Finnish inpatient clinic. The therapists pose questions when the patient has said something that clearly hints at a symptom of addiction. The questions are designed as (disjunctive) yes/no questions which offer to the patient two alternative formulations of their talk to choose from. The first alternative hints at less problematic use of alcohol, and the latter, often an only implicit alternative, hints at more problematic consumption. This order offers to the patient an opportunity to choose the less problematic version in a preferred manner – if they are to display themselves as not having more problems with consumption than anyone else. The therapists can, then, use the patients’ responses to monitor how they have adopted the treatment and the diagnosis of addiction, that is, whether they are resistant or compliant.

Surrender to win: Constructions of 12-step recovery from alcoholism and drug addiction

“…Turning to Eddie, while our reading of Eddie's interview suggests that he constructed himself as the object of power relations of the sort identified by Halonen (2006), it is significant that Eddie was nonetheless able to construct himself as able to exercise agency and self-determination by choosing to drink alcohol and continue attending NA meetings. If AA/NA was a genuinely totalising discourse, it is hard to see how the subject would be able to step out of it.…”

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Assessing candidates for adoptive parenthood. Institutional re-formulations of biographical notes

“…The other function is that of assessment, where life stories are used as a diagnostic tool to collect relevant information to find out about or to check on someone's physical or mental state. Halonen (2006) showed that life stories are used as evidence for assessing addiction. In this research, therapists used yes/no questions to establish facts, such as about "increased drinking" and "loss of control", in order to arrive at a diagnosis and to confront the patient with being an addict (cf.…”

Conversation analysis and the study of social institutions: methodological, socio-cultural and epistemic considerations

“…Several recent studies are consistent with this finding (Antaki, 2008;Antaki, Barnes and Leudar, 2005;Peräkylä, 2004;Vehviläinen, 2003). On the other hand, formulations have been shown to be appropriate devices for the purposes of history-taking, selecting a candidate problem and establishing it as therapeutically relevant (Antaki et al, 2005;Davis, 1986;Hak and de Boer, 1996;Halonen, 2006;Vehviläinen, 2003). Formulations, also, have been described to be employed by patients to elaborate on the therapist's interpretations (Peräkylä, 2005).…”