The Discursive Performance of the Alliance in Family Therapy: A Conversation Analytic Perspective

Abstract

210Following the 'discursive' turn in family therapy, the attention of practitioners shifted towards understanding how culture and language shape meaning-making in therapy. In this article, we demonstrate how conversation analysis (CA) can be used to examine the processes and outcomes of systemic/constructionist practice. We used CA to study collaborative interactions of a renowned constructionist therapist Karl Tomm and one client-family. Viewing collaboration as a pivotal aspect of the therapeutic alliance, we demonstrate how the 'split' within-system alliances were developed and sustained in the course of therapy and how they were discursively transformed into 'intact' alliances. The therapist's efforts to align with perspectives of family members (and subsystems) seemed pivotal in this process.In the mid-1980s family therapy 'went' postmodern. The postmodern critique of conventional family therapy revolved primarily around the issue of therapist power and influence vis-à-vis families. The proponents of postmodernism challenged an instrumental, hierarchical approach to working with clients and advocated replacing it with a more collaborative, participatory engagement. What this collaborative engagement entails has remained a matter of controversy; nonetheless, the collaborative dimension of the therapeutic relationship has become a distinguishing feature of postmodern therapies and some have even used the term 'collaborative' to refer to postmodern approaches to working with families (Perlesz & Brown, 2005).Against this backdrop, we discuss a research study that investigated the use of language in postmodern, 'collaborative' therapy. Our objective in writing the article is twofold. First, we offer an exploratory account of how an avowed collaborative therapist shared his expertise in interaction with a family in ways that acknowledged and utilised family members' understandings and preferences.For us, therapeutic collaboration, and therapeutic alliance more broadly, 1 is created and sustained through repeated collaborative interactions. By observing specific examples of collaborative client-therapist interaction, it may be possible to understand better how the alliance is built (or not) discursively, that is, in communication. Second, we introduce conversation analysis (CA), a sociological tradition of research, arguing that it has a strong potential both for investigating therapy as an inter-subjective and interactive endeavor, and for offering not only a detailed account of the therapy process but also of its outcomes.We begin the article by providing our conceptual definition of 'collaboration', followed by the key assumptions and practices of CA, along with the details of this study. We conclude with the discussion of the results of a family therapy session facilitated by Karl Tomm, MD. Tomm's major contributions to the field of family therapy relate to how therapists can use language to foster collaborative interactions with families. By attending closely to Tomm's communication with the family we hope to...

A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

“…During the past decades a very limited, though growing number of studies have deployed discourse (DA) and conversation analysis (CA) in family therapy research. Furthermore, it has been argued that DA and CA hold promise for the study of psychotherapy and systemic family therapy and that they are epistemologically fit with the latter (Avdi & Georgaca, ; Strong, Busch, & Couture, ; Sutherland & Couture, ). Both methods are rooted in the hermeneutic qualitative research tradition and were originally developed decades ago (see Wooffitt, for a historical account).…”

“…It also includes the simultaneous attendance to the operation of ideological matters in the case of the latter. In this sense, there is an attempt to ground each analytic claim on the way that participants treat each utterance as evident in the next turn (“next‐turn‐proof”) (Sutherland & Couture, , p. 213). This is juxtaposed with DA's preference for a macroanalytic perspective and the grounding of interpretation on the analyst's preexisting theoretical framework.…”

Realizing Relational Preferences Through Transforming Interpersonal Patterns

“…Despite the advent of change process research (Elliott, 2010;Greenberg, 1986;Sutherland et al, 2013), studies focused on how new meanings and realities are co-constructed through actual conversations in family therapy are scarce (Borcsa & Rober, 2016;Sutherland, LaMarre, & Rice, 2017;Tseliou, 2013;Tseliou & Borcsa, 2018). Past studies have explored how therapy relevant realities (e.g., therapeutic alliance; Sutherland & Couture, 2007;Horvath & Muntigl, 2018) are conversationally constructed, but none of these studies have directly tapped into how family members' preferred ways of relating are talkedinto-being (Tseliou, 2013;Tseliou & Borcsa, 2018). Our aim in this clinical paper was to explore how a theoretically informed concept (TIPs; see below) may help therapists identify various conversational practices involved in the concrete "real-ization" (i.e., conversational co-construction) of family members' relational preferences.…”

Joining revisited in family therapy: discourse analysis of cross‐cultural encounters between a therapist and an immigrant family

“…Family therapy scholars note that developing between‐system alliances (e.g. between the therapist and each client) eventually foster within‐system alliances (among family members) (Panichelli, ; Sutherland and Couture, ). Similarly, in this vignette, the therapist's lexical choice of reframing (‘worried’) after the selective joining with Aisha might have aimed for enhancing the joining between Aisha and Rida beyond selective joining between Aisha and Jennifer.…”

“…In our data, we found a repeated interactional pattern, namely, the therapist's lack of tracking, especially around cultural content and, presumably, its underlying subjective meanings and affective processes for the family. This can compromise joining because the family and therapist ‘fail to coordinate meaning to find a shared language and mutual methods of talking deemed acceptable by all parties’ (Sutherland and Couture, , p. 211, original emphasis).…”