Pragmatik der Veränderung. Группа авторов

      Client change in psychotherapy

      Methodological challenges and analytical affordances of discourse analysis

      Joanna Pawelczyk

      Abstract: The issue of client change in psychotherapy is vital for every therapy approach. Yet, at the same time, the research conducted both from clinical quantitative and qualitative perspectives demonstrates the complexity of not only what client change is, but also of how it should be examined. This paper problematizes the very concept of ‘client change’ as this problematization has critical methodological implications for the research. For example, one of the essential questions to be considered is whose perspective we should adopt as researchers in examining client change.

      Quantitative clinical studies have identified a number of factors that contribute to the effectiveness of psychotherapy (Norcross 2011), yet as Silberschatz (2015: 1) has recently claimed: “little progress has been made in elucidating mechanisms of change”. Little is also known about the interactional process(es) leading to client change. This paper focuses on qualitative approaches to examining client change in psychotherapy.

      Discourse analysis as a qualitative methodology used to investigate language use in context, has the tools to examine the process of client change. Thus it can be complementary to the main empirical psychotherapy research (Elliott 2012). This paper demonstrates how the clinical and discourse analytic perspectives can be combined in researching client change in two ways. Firstly, discourse analysis can evidence how the postulated mechanisms of change are actually accomplished in an interaction between the psychotherapist and the client. Secondly, based on the concept of common factors in psychotherapy (Lambert 2013a), the paper proposes common interactional strategies in psychotherapy fundamental to promoting client change.

      Keywords: client change, discourse analysis, conversation analysis, common factors in psychotherapy, common interactional strategies

      Introduction

      Siri Hustvedt, a well-known American novelist, in her collection of essays entitled “A woman looking at men looking at women. Essays on art, sex, and the mind” makes a reference to her own therapy and change she has experienced as a result of it:

      For six years I have been in psychoanalytically based psychotherapy twice a week, and I have been changed by it. How this has happened remains mysterious. I could tell you a story now, one different from the story I arrived with on that first day, but the dynamics of how one story supplanted another, how talk, often repetitious, circling, speculative, even nonsensical, has achieved a shift in me, I couldn’t explain to you with any precision. I know this: I feel freer. I feel freer in my life and in my art, and those two are finally inseparable (Hustvedt 2016: 118).

      The reference to the near impossibility of explicating change coming from such a sharp thinker and observer of human life as Hustvedt herself, already points to the complexity of capturing how client/patient1 change occurs. Still, Hustvedt talks about one story replacing the other as a testimony to the experienced change and thus feeling liberated. Yet the trajectory of getting from one life narrative to the other cannot be easily identified.

      Watzlawick et al. (1974: 2) challenge the commonsensical opposition between change and persistence and put forward the following seemingly paradoxical assumption:

      …persistence and change need to be considered together in spite of their apparently opposite nature. This is not an abstruse idea, but a specific instance of the general principle that all perception and thought is relative, operating by comparison and contrast.

      Watzlawick et al.’s (1974) claim seems to be of vital relevance to the clients’ work in psychotherapy where their progression, although assumed to be incremental thus moving directly from point A to point Z, typically takes on a more uneven trajectory (see Lambert 2013b). Thus, as it is often claimed by clients, they take – in their view – one step forward toward improvement and then two steps backward. Furthermore, as Watzlawick et al. (1974) imply, whether something or somebody has in fact changed is very much contingent on the position from which the assessment is made.

      Referring now to research on client change, Elliott (2012) – one of the key scholars researching client change – comments on the ‘rigidity’ of looking into, i.e. investigating, client change. He refers to the traditional “mode of understanding” in change process research (CPR) as realist relying on such metaphors as “‘change mechanisms’ (change process as machine) and ‘effective ingredients’ (a pharmaceutical metaphor)” (2012: 69). This in turn implies that there should be a recipe-like procedure to be followed if psychotherapists want to achieve a change of some sort in their clients despite, among others, clients bringing very different issues to therapy and numerous diverging approaches to doing psychotherapy.

      The three views presented above point to a very complex picture of what client change is and what it might entail, its highly contingent character (Watzlawick et al. 1974), as well as the challenges in tracking it down both from the patient’s (Hustvedt 2016) as well as the researcher’s perspective (Elliott 2012).

      In what follows the main trends in qualitative research on client change are presented, highlighting its methodological complexity. Next, the key tenets of conversation analysis as one of the approaches to discursive engagement with (therapeutic) data as well as the emerging conversation analytic research on client change are discussed. This is followed by the analytical section on the use of discourse analytic approaches in investigating client change. The focus of this section is on common factors in psychotherapy (Lambert 2013a) and common interactional strategies of co-construction and re-construction in promoting client change.

      Problematizing

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