Weiste2015b
| Weiste2015b | |
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| BibType | PHDTHESIS |
| Key | Weiste2015b |
| Author(s) | Elina Weiste |
| Title | Relational Work in Therapeutic Interaction: A Comparative Conversation Analytic Study on Psychoanalysis, Cognitive Psychotherapy and Resource-Centred Counselling |
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| Tag(s) | EMCA, Therapy, Epistemics, Empathy, Medical, Prosody, Physician-Patient Relations, Relationships |
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| Year | 2015 |
| Language | English |
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| URL | Link |
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| ISBN | 978-951-51-1042-8 |
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| School | University of Helsinki |
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Abstract
The quality of the therapeutic relationship is highly significant for treatment outcomes in mental healthcare. While the value of the relationship has been clearly documented, the various aspects of how the relationship is actualized in clinical practice have remained unclear. This dissertation breaks new ground in understanding how the therapeutic relationship is manifested in three forms of therapeutic interaction: psychoanalysis, cognitive psychotherapy and resource-centred counselling. The method of conversation analysis is applied to compare these approaches and reveal how specific aspects of the therapeutic relationship are managed in interaction: 1) how therapists express empathy and respond to clients talk on their subjective emotional experiences, 2) how therapists work with experiences that belong to clients personal domains of knowledge, and 3) how disagreements are expressed and relational stress managed in therapeutic interaction. The data comprise audio- and video-recorded encounters from each therapeutic approach (86 encounters in total).
The data analysis reveals the fine-grained interactional practices used in the management of the therapeutic relationship. In all the therapeutic approaches, formulating the client s emotional experience allowed the therapists to display empathic understanding, and prosodic features were important for marking the formulation as either empathic or challenging. In psychoanalysis and cognitive psychotherapy, the client s emotional experiences were typically validated, interpreted or challenged. In the resource-centred approach, the clinicians sought to focus on successful experiences and praised clients agency and competence, while shifting the focus away from their difficult emotional experiences. The data analysis also highlights the complex relationship between emotions and epistemics and describes how a delicate balance between empathic and challenging interventions is manifested in therapists supportive and unsupportive moves during extended disagreement sequences.
This dissertation contributes to three areas of research: 1) clinical research, as it underlines the importance of investigating the actions of the therapist and client in a relational way, furthering comprehension of how the processes associated with the therapeutic relationship appear in the context of interaction between therapist and client; 2) sociological studies on mental health, as this study illustrates some important institutional differences between psychotherapy and psychiatric outpatient care; 3) conversation analysis, as this research provides the first broader systematic comparison of interactional practices in different therapeutic approaches.
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