Burdett, Mark
(2018)
Exploring clients’ meta-comments in psychotherapy using conversation analysis.
DClinPsy thesis, University of Nottingham.
Abstract
Asking clients about shifts in their moment-to-moment experience - for example, when they laugh, smile or make a comment to themselves - is done in a variety of different ways in different therapeutic approaches. However, the various therapies do not necessarily specify what might be happening for the client when a shift occurs, and are instead more interested in the therapist’s response to those events. Method of Levels (MOL) therapy does however, make a series of claims about what is occuring for the client during those shifts, termed ‘disruptions’. Disruptions are proposed to be short responses, offering comments on a client’s own talk, which are not spontaneously elaborated on. Asking about disruptions in MOL is one of the two over-arching goals of the therapy (Carey, 2006). As MOL emphasises these disruptions so heavily, instances when shifts occured during clients’ talk were assessed against MOL’s proposals.
Conversation Analysis (CA) was used to explore a corpus of recordings from a university counselling service for possible “disruptions” (as defined above). Due to the breadth of potential disruptions, clients’ explicit comments on their own talk were prioritised for exploration. Instances of clients referring to their own talk with the format “sounds [X], but [Y]” (SBs), e.g. “it sounds so bad … but it’s the truth”, were collected and reviewed. SBs were used by the clients to disclaim a named negative hearing of their talk (sounds [X]), to create a favourable interactional environment to disclose a sensitive issue to the therapist (but [Y]). It is argued that the “sounds [X]” component represents a potential hearing for both the client and the therapist. A range of therapist responses to SBs are discussed, including responses which are affiliative and non-affiliative, alongside the client’s subsequent response.
The study has two main implications. Firstly, it provides a detailed account of clients’ actions when they attend to issues of immediacy, inter-subjectivity and making a disclosure, which are of interest beyond MOL, and typically explored from the therapists’ perspective. In discussing and exploring the range of therapist responses using CA (which is non-cognitive), a contrast is provided with psychotherapies’ typically cognitive approach. The contrast in approaches provides an opportunity for reflection on whether therapists’ actions are aligned to their own therapeutic goals when a client uses an SB. Secondly the study supports a number of MOL’s proposals: potential disruptions were transitory; and without therapists asking about SBs, clients resumed their prior talk. However, MOL’s account of disruptions does not highlight the social actions of talk that CA emphasises.
A brief unstructured exploration of disruptions was also undertaken prior to the CA study. The exploration included looking at the disruptions highlighted by MOL therapists during therapy, the types of disruptions identified by the author from example videos, and whether there were frameworks from literature other than MOL that could inform the identification of disruptions as attentional shifts. No clear framework was identified, but Poyatos’ (1983) proposition of language consisting of language, paralanguage and kinesics was informative.
The systematic literature review reflects an alternative quantitative approach to exploring MOL’s propositions. A design using this approach was abandoned due to a combination of the low association found in the meta-analysis and feasibility of testing this; discussion with my supervisors; feedback on submitting the paper to Personality and Individual Differences; and the ensuing development of my thinking and interest.
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