Integrative Psychotherapy Articles
School of English
Adam Mickiewicz University
Institute for Integrative Psychotherapy
Expressing the unexpressed: the interactional construction of verbalization in the context of psychotherapy sessions.
The psychotherapy session remains an example of unstudied occupational activity (cf. Labov & Fanshel 1977, Ferrara 1994). Psychotherapy entails facilitating clients to examine an issue from a new angle; this is mainly achieved through talk, thus rendering psychotherapy a “talking cure”. This paper describes how the psychotherapist - through phenomenological inquiry - enables the client to verbalize significant aspects of self, aspects that may never have been verbalized or, if verbalized, have never received an empathetic response from an interested listener. This paper presents how specific communicative strategies and language forms take on therapeutic value in the discussed context, underlining that the communicative function is not pre-ordained but rather it remains to be actively constructed in discourse. The data for this research project was gathered from audio recordings of actual therapy sessions conducted in August and October, 2004. These recordings document the practical application of a Relational Psychotherapy approach based on such categories of methods as, among others, inquiry, attunement, involvement (Erskine, Moursund, & Trautmann, 1999).
KEYWORDS: relational psychotherapy, discourse of psychotherapy, conversation analysis, verbalization
Psychotherapy constitutes a process of self-disclosure in which the clients discover facets of themselves, uncovering previously unconscious or not thought about experiences. Through psychotherapy, clients shift the perception of themselves and new relational possibilities become available making behavioral change possible. The psychotherapist’s phenomenological inquiry as linguistically represented by a set of context-sensitive strategies (e.g., discourse markers, repetitions) leads to the client’s verbalization of the ‘unexpressed’, i.e., experiences that have never been openly talked about or verbally revealed to anyone.
Verbalization of the unexpressed does not function in the context of psychotherapy as a mere expression of past events. On the contrary, it has every potential to be performative (cf. Austin 1962). In psychotherapy the verbalization of one’s phenomenological experience turns the previously unconscious or unexpressed experience into material entity amenable to intrapersonal and interpersonal contact (Frosh, 1997; Staemmler, 2004).
This article examines the communicative strategies inducing verbalization of clients’ experience in its most endemic setting, i.e., the context of psychotherapy sessions. However, verbalization, although typically characterizing the intimate discourse contexts (psychotherapy featuring its almost hypertrophied form), appears to play a crucial role in a person’s self- understanding across various everyday contexts of communication, as to verbalize is to bring into existence one’s experience by way of sharing it with an interested listener. The discourse of psychotherapy, the linguistic patterns and communicative strategies used in interactions between client and psychotherapist in the context of a psychotherapy session, has not drawn substantial attention of linguists interested in the study of language in the social context. This neglect is quite paradoxical since, in all of the approximately 400 forms of psychotherapy to date (Bongar & Beutler 1995), the primary therapeutic ingredient is provided through dialogue. Russel asserts “Today, the idea that a clinician’s talk is instrumental in facilitating client change is as little contested as the idea that clients’ talk can be a helpful indicator of their psychological well-being” (1987: 1). A number of researchers, notably Gaik (1992), Kiesler (1973), and Russel & Stiles (1979) outline a number of reasons accounting for the lack of research and/or its deficiencies. According to Gaik (1992), the major problem concerns the number of approaches to doing psychotherapy (cf. the so-called eclectic phrase, Gaik 1992: 272), rendering it close to impossible to propose a comprehensive analysis of this discourse (Friedlander 1984: 335). Small and Manthei (1986) refer to “many competing terminologies provided by the various specific theories” as an obstacle to describe therapy in “general terms” (395).
Secondly, the highly affective nature of such psychotherapy interactions (cf. the genre of intimate discourse, Gerhardt & Stinson 1995: 630) linked to the issues of confidentiality and data collection poses a challenge. Gale (1991: IX), additionally states that therapy rests on the idea that “each person is an exception and no session is typical”. Yet, despite the numerous approaches to therapy, its aim can be quite uniformly defined as “getting people to see things from new angles” (Gale 1991: IX); thus researchers should look into how the end, i.e., a client’s self-transformation (cf. Gerhardt & Stinson 1995: 635), is brought about linguistically. In other words, it should be explored ‘across-numerous therapy contexts’ how psychotherapy is linguistically realized and contextually achieved. Still, even in view of the identified obstacles to a comprehensive analysis, it is increasingly important to investigate the discourse of psychotherapy for at least three reasons. Firstly, an increasing number of people seek psychotherapeutic assistance. Secondly, psychotherapy remains a marked speech event “and has the power to evoke the therapeutic activity in ordinary conversations” (Gaik 1992: 73, also cf. Lakoff 1980). Thirdly, Cameron (2000) refers to therapy or rather therapy/therapeutic qualities as one of the most defining elements in the current model of communication: “it appears to be true that communication skills training materials draw on expert knowledge produced mainly within the fields of psychology and therapy” (2000: 46). Moreover, ‘therapeutic skills and values’ tend to be currently applicable in a number of business contexts, e.g., call centers (cf. Cameron 2000; Kielkiewicz-Janowiak and Pawelczyk 2004), where the preferred model of communication entails a great deal of ‘emotional labor’ (cf. Taylor and Tyler 2000). Cameron (2000) refers to Giddens (1991: 180) who describes therapy as “methodology of life planning”, clearly demonstrating the importance of self knowledge and understanding - the key elements of therapy - in planning and living a successful life in the post modern world. To sum up, the multifaceted ‘talking cure’ has come out of the therapy room and entered a magnitude of other contexts whose agents (usually with little or no training as psychotherapists) eclectically and selectively draw on its discourse (cf. Fairclough’s technologizing of discourse 1989, 1992). Nevertheless, what unites all the potentially divergent contexts in which therapeutic values or skills are esteemed is the importance of verbalizing one’s experience.
The function of the psychotherapist’s phenomenological inquiry is to “symbolize,
transform, and displace a stretch of experience from our past - what we have
done, what has happened to us - into linguistically represented episodes, events,
processes, and states” (Schiffrin 1996: 168). In 1942, Carl Rogers
recognized that one of the most significant features of any type of therapy
is “the release of feeling”, i.e., the verbalization of “thoughts
and attitudes, those feelings and emotionally charged impulses, which center
around the problems and conflicts of the individual” (131). Although ‘the
release of feeling’ can take on a non-verbal form, here verbalization
refers only to the experience that has been conveyed verbally. Rogers claimed
a very agentic role for a psychotherapist in the process of the “release
of feeling”. The psychotherapist is in a position to adopt various
methods and techniques enabling the client a free expression of the emotionalized
attitudes. As Staemmler (2004: 49) observes, “one feels satisfied and
is left with the impression that one has understood oneself fully” only
after sharing one’s preexisting meanings with another person. It follows
that overtly stating out loud what one has been through to others helps one
comprehend the experience. Moreover, Staemmler attributes verbalization
to the human dialogical nature due to which an interpretation and understanding
of one’s experience is only satisfactory once it is co-created through
an emphatic exchange. This is in line with Bakhtin (1986) who similarly asserts
that: “…I become myself only by revealing myself to another, through
another and with another’s help”. Taylor (1992: 36) furthers this
notion by asserting that self-understanding is very much dependent on sharing
one’s feelings verbally with others. Taylor’s conceptualization
also touches on the aspect of one’s identity as existing only in reference
to others with whom the experience is shared: “even as the most independent
adult, there are moments when I cannot clarify what I feel until I talk about
it with certain special partner(s), who know me, or have wisdom, or with whom
I have an affinity…This is the sense in which one cannot be a self on
one’s own. I am a self only in relation to certain interlocutors” (Taylor
1992: 36). Naming an already experienced situation brings it into consciousness
and facilitates its identification (Stubbs 1997: 371). Needless to say,
language and communicative strategies feature prominently in the process of
verbalizing one’s experience and thus in the process of repairing, stabilizing,
or enhancing a sense of Self. As Mercer (2000: 1) aptly stated, we use
language for thinking together as well as for collectively making sense of
experience and solving problems. Yet, this function of language, as a tool
for carrying out our joint intellectual and emotional activities, tends to
be predominantly taken for granted.
Cameron (2000) refers to verbalization of one’s experience as the production of coherently satisfying narrative in order to be more effective and authentic in communication. This is where verbalization and psychotherapy meet in the incessant process of voicing and integrating various past and present experiences into a consistent narrative. The common cliché, “don’t bottle things up’ signifies that “talking is good because it ‘defuses’ explosive inner states” (Cameron 2000: 157). As a result, it can be concluded that there exists widespread folk awareness of the importance of not merely feeling certain emotions and experiences but, more importantly, actively verbalizing them. In sum, verbalization of one’s experience to a significant other who actively listens and provides an empathetic response clarifies and in turn validates one’s emotions. Such psychotherapeutic dialogue brings emotions and repressed experiences into consciousness.
Verbalization and ‘coming-out’ stories.
The process of verbalizing one’s experience and concurrently constructing a new facet of one’s identity can be pertinently illustrated with the so-called ‘coming-out’ stories typical of an open declaration of one’s alcoholism, homosexuality, or history of emotional or sexual abuse. In the therapeutic dialogue, verbalization, as an act of self-disclosure, does not merely indicate an act of sharing one’s experience with an interested listener but rather it also has potential to repair, stabilize and/or enhance a person’s sense of well-being, i.e. to be performative (cf. Austin 1962, Barret 2002). As Chirrey (2003) asserts coming out can take two forms, admitting to oneself one’s experience, emotion or identity (where it is typically considered an internal psychological process) and also communicating that identity, emotion or experience to another. The latter type of coming out is inherently linked to a verbal undertaking - verbalization of one’s phenomenological experience, such as inner affects, thoughts, fantasies, expectations, or body sensations. Telling one’s personal story may create a new identity for either the speaker or the listener or both. For example, in the introduction of an Alcoholics Anonymous meeting (e.g. “My name is Bill and I am an alcoholic), the person’s identity is established with both himself and the group. The same process occurs in psychotherapy where a client may finally “come out” to the therapist by talking about the sexual or physical abuse that they received as a child. The therapist’s empathetic response facilitates further telling of the client’s narrative (Erskine 1993). As Chirrey claims (2003) one can not come out by means of other semiotic systems and only open verbalization enables gay and lesbian individuals, alcoholics or abused children to create a new aspect of his or her identity. She gives an example of Fran who believed that her mother knew that she was a lesbian, but she did not consider being out to her mother until she verbalized her lesbianism. In this way individuals present to the involved listener the new phenomenological identity and sense of Self. This is in line with Foucault (1978) who believes that it is the act of naming ‘homosexuality’ or “alcoholism” or “abuse” that brings it into being. In other words, an open assertion and recognition of one’s gayness, or drug addiction or depression, is a speech act provided that it is accepted and acknowledged by the listener’s emotional or verbal expression of empathy. In sum, phenomenological inquiry and subsequent verbalization of emotions, fantasies, memories or identity, can be performative as it enables the emergence, substantiation, and possible acceptance of a person’s feelings and identity. ‘Coming out’ is therefore a speech act that not only describes the speaker’s identity, but also brings the new Self into being.
Verbalization and psychotherapy
Emotional expression, the formation of identity, verbalization of the previously
unexpressed and coming-out stories are all the result of an intimate dialogue
in psychotherapy. In the psychotherapeutic setting verbalization constitutes
the most essential - even defining - speech act without which psychotherapy
loses its primary function, i.e., bringing about a self-reflective stance to
reveal problematic emotional material in order to understand it anew (Gerhardt
and Stinson 1995) and possibly change behavior. As Russel (1987) states, Breuer
and Freud were the first therapists to notice the weight of verbalization of
emotional states: “the psychical process which originally took place
must be repeated as vividly as possible; it must be brought back to its status
nascendi and then given verbal utterance” (1981: 7). Across the
numerous approaches to doing psychotherapy, clients are encouraged to verbalize
their experiences by adopting a self-reflective stance. In other words, a client
is invited to scrutinize his or her thoughts, feelings, fantasies, motivations
and behaviors (cf. Bruner 1990; Erskine, Moursund & Trautmann,
1999). In the process of the client’s verbalizing internal phenomena
- often facilitated by the therapist - the internal is manifested externally
and becomes more real, part of the dialogue of the therapeutic relationship
(Frosh 1997; Staemmler 2004). Verbalization of phenomenological experience
redefines the relationship between the interacting parties, thus rendering
the interaction intimate - an element of relational psychotherapy. In the context
of psychotherapy the client is encouraged to give voice to - and thus verbalize
- a traumatic or troublesome experience to the therapist, thus they are revealing
it to themselves at the same time, frequently for their first time in their
lives. It can be then claimed that in this context the verbalization of experience
to oneself and to another person (the therapist) characteristically overlap.
In fact, successful therapy involves the therapist’s phenomenological
inquiry that facilitates the client’s bringing back into consciousness
that which has been unconscious: the unexpressed thought, the never verbalized
affect, the interrupted fantasy, or the intentionally denied experience.
Psychotherapy provides ample room for the therapist’s misunderstanding of the client’s attempt to verbalize his or her internal experiences. Such a mismatch in the context of psychotherapy constitutes a “therapeutic error” (Guistolise 1997). It is in the process of the therapist’s identifying and correcting therapeutic misattunements and errors that often more significant phenomenological experiences can then be verbally expressed (Moursund and Erskine 2004: 192-5). Furthermore, the potential mismatch in how the verbalized material is comprehended by the client and therapist can be worked out by both parties in view of the dialogical nature of psychotherapy.
In sum, the aim of verbalization in therapy as Labov and Fanshell (1977: 32) asserted is motivating the patients into introspection and the discovery of evermore profound aspects of Self. Psychotherapy is a “…struggle to resymbolize, to put into words that which has not been or cannot be spoken” (Frosh 1997: 76 ). Consequently, a therapist’s communicative strategies - an exemplification of his or her values, phenomenological inquiry, attunement and involvement - play a crucial role in helping clients discover and explore the uniqueness of who they are both internally and in relationship with others.
A Relational Psychotherapy
In the last 25 years, a major paradigm shift has occurred in the field of
psychotherapy, wherein the focus of therapy is on a contactful relationship
between client and therapist. This paradigm shift has occurred in various
approaches to psychotherapy, whether they are contemporary Psychoanalysis,
psychoanalytic Self-psychology, Integrative Psychotherapy, Transactional Analysis
or Gestalt Therapy. Even many cognitive-Behavioral psychologists
currently recognize the importance of an effective interpersonal relationship
as a basis for the client’s making behavioral change. A review
of the developmental psychology and psychotherapy literature reveals that the
single most consistent concept is that of relationship - both in the early
stages of life as well as throughout adulthood (Erskine 1989). A contactful
interpersonal relationship is the source of that which gives meaning and validation
to the self.
A major premise of a relational psychotherapy is that the need for relationship constitutes a primary motivating experience of human behavior, and contact is the means by which the need is met. Contact occurs internally and externally; it involves a full awareness of sensations, feelings, needs, sensory motor activity, thoughts and memories that occur within the individual and a shift to full awareness of external events as registered by each of the sensory organs. Contact also refers to the quality of contact between two people: the awareness of both one’s self and the other, a sensitive meeting of the other and an authentic acknowledgement of one’s self. A guiding principle of a contact oriented relational psychotherapy is the therapist’s respect for the client’s integrity. Through respect, kindness and compassion, a therapist establishes an interpersonal relationship that provides affirmation of such integrity. This respectfulness may be described best as a consistent invitation to interpersonal contact between client and therapist, with simultaneous support for the client’s contacting his or her internal experience and receiving external recognition of that experience. Withdrawing from contact may often be identified and discussed but the client is never forced, trapped or tricked into more openness than he or she is ready to handle. Contact between client and therapist is the therapeutic context in which the client explores his or her feelings, needs, memories and perceptions. Interpersonal contact provides the safety that allows the client to drop defenses, to feel again, to remember and to tell his or her life story in a dialogue with an interested, caring and psychologically informed listener. Effective psychotherapy is a creative, interpersonal dialogue, based on the therapist’s respect for the client’s unique process of communication, what Carl Rogers (1951) referred to this as “unconditional positive regard”. This respect, or unconditional positive regard, is demonstrated through the therapist’s inquiry, attunement and involvement.
Inquiry is a constant focus in a contact-oriented relational psychotherapy. It
begins with the assumption that the therapist knows nothing about the client’s
experience and, therefore, must continually strive to understand the subjective
meaning of the client’s behavior and intrapsychic process. The
process of inquiry involves the therapist being open to discovering the client’s
perspective while the client simultaneously discovers his or her sense of self
with each of the therapist’s awareness-enhancing statements or questions. As
a result of respectful investigation of the client’s phenomenological
experience, the client becomes increasingly aware of both current and archaic
needs, feelings and behaviors. Affect, thoughts, fantasy, core beliefs,
body movements or tensions, hopes and memories that have been kept from awareness
by lack of dialogue or by psychological repression may come to awareness. With
increased awareness and the relaxing of psychological defenses, needs and feelings
that may have been fixated and left unresolved due to past experiences may
now be expressed through an interpersonal dialogue.
It should be stressed that the process of inquiry is as important, if not more so, than the content. The therapist inquiry must be empathetic with the client’s subjective experience to be effective in discovering and revealing the internal phenomena (physical sensations, feelings, thoughts, meanings, beliefs, decisions, hopes and memories) and in uncovering the internal and external interruptions to contact. Inquiry involves constantly focusing on the client’s experience of affect, motivation, beliefs or fantasy and not on behavior alone or a problem to be solved. Such phenomenological inquiry requires the therapist’s genuine interest in the client’s subjective experience and construction of meanings. Phenomenological inquiry proceeds with questions about what the client is feeling, how he or she experiences both self and others (including the psychotherapist), and what meanings and conclusions are made. With sensitive, respectful inquiry, clients will reveal previously repressed fantasies and out-of-awareness intrapsychic dynamics. This provides both the client and the therapist with an ever-increasing understanding of who the client is, experiences he or she has had, and when and how he or she interrupts contact.
Inquiry may include an exploration of intrapsychic conflicts and unaware enactments of childhood experiences and continue with historical questions as to when an experience occurred and the nature of significant relationships in the person’s life. Through inquiry we explore the client’s core beliefs and related behaviors, fantasies and reinforcing experiences (Erskine and Zalcman 1979). In accordance with the client’s welfare, the therapist may integrate Gestalt therapy experiments, behavioral change contracts, body psychotherapy, intensive therapy of introjected parental figures, or developmental regression (Erskine and Moursund 1988). Through a combination of these techniques for enhancing self-awareness and through the therapist’s respectful inquiry, experiences that in the past were necessarily excluded from awareness can again be remembered in the context of an involved therapeutic relationship. With memories, fantasies or dreams coming to awareness the therapist’s inquiry may return to the client’s phenomenological experience or proceed to the client’s strategies of coping, that is, to an inquiry about the defensive internal and external interruptions to contact.
Attunement is a two part process: it begins with empathy - that is,
being sensitive to and identifying with the other person’s sensations,
needs or feelings - and the communication of that sensitivity to the other
person. More than just understanding or vicarious introspection, attunement
is a kinesthetic and emotional sensing of the other - knowing his or her rhythm,
affect, and experience by metaphorically being in his or her skin, thus going
beyond empathy to provide a reciprocal affect and/or resonating response. Attunement
is more than empathy:
it is a process of communion and unity of interpersonal contact. Effective attunement also requires that the therapist simultaneously remains aware of the boundary between client and therapist as well as his or her own internal processes. Attunement is facilitated by the therapist’s capacity to anticipate and observe the effects of his or her behavior on the client and to decenter from his or her own experience to extensively focus on the client’s process.
The communication of attunement validates the client’s needs and feelings and lays the foundation for repairing the failures of previous relationships. Attunement is communicated not only by what the therapist says, but also by facial or body movements that signal to the client that his or her affects and needs are perceived, are significant and make an impact on the therapist.
Attunement is often experienced by the client as the therapist gently moving through the defenses that have prevented the awareness of previous relationship failures and the related needs and feelings. Attunement facilitates contact with long-forgotten memories. Over time this results in a lessening of internal interruptions to contact and a corresponding dissolving of external defenses. Needs and feelings can increasingly be expressed with comfort and assurance that they will receive an empathetic and caring response. Frequently the process of attunement provides a sense of safety and stability that enables the client to begin to remember and to endure regressing therapeutically into childhood experiences that may bring a fuller awareness of the pain of past traumas, past failures of relationship(s), and lost of aspects of self. The process of attunement can be categorized according to the resonance and reciprocity required for contact-in-relationship. This attunement may be to the client’s rhythm, level of development, nature of affect or relational need.
Involvement is best understood via the client’s perception; it is a sense that the therapist is contactful. It evolves from the therapist empathetic inquiry into the client’s experience and is developed through the therapist’s attunement with the client’s affect and validation of the client’s needs. Involvement is the result of the therapist being fully present, with and for the client in a way that is appropriate to the client’s developmental level. It involves a genuine interest in the client’s intrapsychic and interpersonal world and a communication of that interest through attentiveness, inquiry and patience. Involvement begins with the therapist’s commitment to the client’s welfare and respect for the client’s phenomenological experience. Both internal and interpersonal contact become possible when the client experiences that the therapist: 1/ respects their way of being, even their defenses; 2/ stays attuned to his or her affect or needs; 3/ is sensitive to the psychological functioning at the developmental age wherein he or she may be psychologically stuck; 4/ is interested in understanding the client’s way of constructing the meaning of life’s experiences. Therapeutic involvement that includes acknowledgement, normalization, validation and presence facilitates both internal and external contact.
A contact-oriented relationship psychotherapy that centers on inquiry, attunement
and involvement responds to the client’s current needs for an emotionally
nurturing relationship that is reparative and sustaining. The aim of
a relationally oriented psychotherapy is the integration of affect-laden experiences
and psychological fragmentation and an intrapsychic reorganization of the client’s
fixated core beliefs about self, others and the quality of life.
A guiding principle of this contact-oriented, interactive psychotherapy is respect for the integrity of the client. Through respect, kindness, compassion and maintaining contact the therapist establishes a personal presence and facilitates an interpersonal relationship that provides affirmation of the client’s integrity. The psychotherapy methods used are based on the belief that psychological healing occurs primarily through the interpersonal contact of the therapeutic relationship. With such psychological healing it becomes possible for the person to face each moment with spontaneity and flexibility in solving life’s problems and in relating to people.
CONSTRUCTION OF VERBALIZATION IN PSYCHOTHERAPY SESSIONS
Data and methods of analysis
The examples used for the analysis come from the corpus (65 hours) of psychotherapy
sessions recorded during the fieldwork at psychotherapy workshops in the summer
and autumn of 2004. The recorded material has been transcribed
with the focus both on utterance as well as interactional content (see transcription
conventions p. 27). In accordance with Schiffrin’s claim (1987: 68) all
the examples presented and discussed below are not based on a single occurrence
of the investigated strategy. They constitute representative instances of typical
patterns found across the whole corpus. At the same time, since the analysis
has been concerned with the very context of psychotherapy only, the referred
functions of discussed communicative strategies should be interpreted in terms
of sequential accountability (cf. Schiffrin 1987: 69). The analysis extensively
draws on the methods from Conversational Analysis as they proved to be successful
in explicating communicative strategies and conversational practices applied
in the psychotherapy contexts (cf. Hutchby 2002, Vehviläinen 2003, Antaki
et al. 2005, Pudlinski 2005). The theoretical introduction into the analysis
is also informed by the insights from pragmatics.
As has already been underlined, verbalization of the ‘unexpressed’ i.e. the release of some aspects of experience and typically connected with it some pent up emotions, constitutes the most important task a therapist faces in the interactions with clients. It is the most significant aspect, yet merely preliminary, but still an absolutely necessary step for the client to facilitate the long-awaited personal change. Bruner (1990) refers to one’s deeds, acts and experiences in general as aspects of agentive self, similarly Gerhardt and Stinson (1995) talk about aspects of experiential self. Those are the significant facets of self that need to be addressed by the client with the assistance of a therapist. Once self-disclosed, these facets become material entity (Frosh 1997) or manifest material (Staemmler 2004) amenable to therapeutic work. As Erskine et.al.’s research (1999) confirmed, among the eight relational needs inherent in all human relationships are the needs for validation, self-definition and to make an impact on the other person. When these relational needs are responded to in psychotherapy, an individual can more readily express aspects of self that may have previously been unexpressed.
The analyzed material of the Integrative Psychotherapy sessions evinces that self-disclosure, i.e. verbalization, can be triggered in three major ways, each of which require the active involvement of a therapist. The first, which constitutes the subject matter of this article, is the use of communicative strategies that redefine and trigger clients’ verbalization. The second and third referred to as ‘phenomenological inquiry’ (cf. pages 8-9) and ‘priming the pump’ are the subject matter of a forthcoming article. Phenomenological inquiries are questions about subjective experience, such as “what are you feeling?” or “what is that like for you?”. ‘Priming the pump’ is an open-ended prompt provided by the therapist that amplifies the client’s emotions or incomplete thoughts, such as “tell him why you are so angry” or “say what else you need”. ‘Priming the pump’ involves very direct interactional work to be performed by the therapist as the proposed prompts constitute immediate interactional challenge that needs to be completed immediately or there is a break in the conversational flow.
The subject of this article is the therapist’s active communicative strategies that lead to the client’s increased verbalization. Yet, we label the process as indirect for two main reasons.
Firstly, unlike ‘phenomenological inquiry’ and ‘priming the pump’, the client is not directly prompted to complete the initiated, open-ended thoughts but rather the therapist relies on the communicative strategies employed by the client to elicit verbalization. Secondly, the interactional meaning and function of these strategies are redefined by the therapist (in the context of psychotherapy sessions) in order for them to act as verbalization triggers. Consequently, their functions become contextually sensitive, but interactionally marked. Here the use of the discourse marker you know, the use of repetitions as well as you-oriented-inquiry will be discussed.
Discourse markers and you know
One of the most important verbalization triggers utilized by the therapist
in the interactions with clients is the discourse marker (or pragmatic particle) you
know or its variant I don’t know.
Although discourse markers (DMs) are used to indicate relationship between discourse units thus creating coherence within a speaker’s turn, the current discussion will focus on the function of the discourse marker you know as indexing the relationship between one speaker’s utterance and another’s response (cf. Schiffrin 1985). Discourse markers generally fall into two main divisions. One has been proposed by Redeker (1990) who divides DMs into ideational, subsuming connectives and temporal adverbials (e.g. and, meanwhile, now), and pragmatic with such DMs as: oh, all right, well. Redeker states that ideational DMs tend to be used between strangers, while the pragmatic ones feature prominently in the conversations between friends. Jucker and Smith (1998), on the other hand, propose the division into reception and presentation DMs. According to this paradigm reception markers, e.g. oh, yeah, okay are typically applied in interactions between strangers where more feedback is needed from the listeners as to how they are incorporating the new information. The presentation markers, e.g. like, you know, well tend to prevail in conversations between friends as “the speaker is better equipped to provide advice on how to process her words and this information is encoded in presentation markers” (Fuller 2003: 26). Despite different attempts to classify DMs, the most constitutive feature of DMs is that they are optional, in the sense that “the informational segmentation of the argument would remain intact without the markers” (Schiffrin 1987: 51). In other words, the optional aspect of DMs manifests itself in the fact that they do not change the truth conditions of the propositions in the utterances they frame (Schourup 1999: 232). Even though DMs are not obligatory in the clauses, they perform great interactional work (cf. Fuller 2003), and their functions can be multiple rendering this conversational strategy highly context-sensitive. One such discourse markers is you know. The literal thus referential meaning of this DM implies its function in information states. Yet, scholars tend to agree that you know creates focus on the information it frames and does not suggest that the hearer knows what is being said. As Fuller (2003) concludes, you know is frequently used in contexts where the hearer is clearly presented with new information (cf. also Fuller 1998 and Brinton 1990). Schiffrin (1987) offers a very elaborate discussion on the functions of you know. She advocates that you know does indeed mark information states but tends to be used in order to present new information which the speaker wishes to accept by the hearer (cf. also Östman 1981). The use of you know aims at gaining hearer involvement in an interaction as this DM “seems to be marking some kind of appeal from speaker to hearer for consensus” (Schiffrin 1987: 54). The author proposes that you know signifies speaker/hearer alignment in the conversation (1987: 54). Schiffrin also states that the intonational contours assigned to you know reflect pragmatic difference in the speaker’s certainty about the hearer’s knowledge. According to Schiffrin (1987: 291) you know with rising intonation is a sign of less certainty about shared knowledge between the speaker and the hearer compared to you know with falling intonation (cf. Bolinger 1982). Other researchers investigating this DM across numerous contexts, thus adopting the approach of distributional accountability (cf. Schiffrin 1987: 69), propose further functions of you know. He and Lindsey (1998) argue that the investigated DM increases the salience of the information it frames. Schourup (1985), on the other hand, claims that the fundamental meaning of you know is “to check the correspondence between intended speaker meaning and hearer information state” (Fuller 2003: 27). Holmes (1986) concludes that not a single function can be attributed to the use of you know: “there is no doubt about the fact that you know may be used primarily to appeal to the addressee for reassurance. It may equally be used, however, as an ‘intimacy signal’ and a positive politeness strategy, expressing solidarity by generously attributing relevant knowledge to the addressee” (1986: 18). Although numerous studies have focused on the pragmatic functions of you know, the issue of how these functions feature across various social contexts has not been sufficiently addressed (cf. Fuller 2003: 25).
Freed and Greenwood (1996) found that although the occurrence of you know is endemic to the conversational context, the subjects of their study employed this discourse marker most often in the type of conversation referred to by the authors as ‘considerate talk’. In this type of conversation the subjects were focused on the topic of friendship. Freed and Greenwood attributed the greatest use of you know by the subjects in this conversational context to their conscious engagement in talking to one another as well as the nature of the subject itself. It can be concluded then that (highly) intimate conversations (i.e. intimate context) prompts greater use of you know. Consequently, it can be hypothesized that the conversational practices of psychotherapy should be abundant in you know tokens as clients share with the therapist the most intimate, i.e. personal aspects of their lives. Precisely, even a cursory look at client-psychotherapist exchanges proves this hypothesis. However, on closer discourse-based analysis there emerges a major qualitative difference between two types of you know. The key difference lies in the fact that while the first type can be generally referred to as an element of high-involvement style, the use of the second type, more importantly, leads to the client’s verbalization of some of his or her distressing life experiences.
The function of the first type of you know produced by clients can be interpreted as an intimacy-building strategy. Out of the above discussed functions of you know, this DM may appear to be redundant as a strategy to present new information that the speaker (client) wishes the hearer (therapist) to accept due to the rule of ‘unconditional positive regard’ (cf. Rogers 1952). Also, the use of you know to gain hearer’s involvement should be excluded since a therapist is acutely aware of how important his constant involvement in what the client is saying is (cf. the discussion above). The first type of you know as an intimacy-building strategy, tends to precede a potentially threatening or traumatic thought or idea that is about to be revealed by the client:
Extract 1 (C- client; T- therapist)
1 C On Friday evening >after< we did the presentations, several people came to you for a HUG,
2 and first thought was ‘WOW, I’d like that too”, I was quite envious >actually<. And then I
3 noticed on that Saturday and yesterday I started protecting myself against that thought saying ‘ 4 no:: , other people need it mo::re than you, you really need ↑ that what for ?’, and (1.0) you
5 know, that’s the ARmor (1.0) also.
7 T ‘other people need it more’ is a very typical theme that the oldest child in the family would
8 often say to discount their own discomforts.
In extract 1, new, emotionally and therapeutically significant material follows you know. The example shows how you know is followed by an element that becomes the thematic link of the session (the armor). You know in the above example is juxtaposed with a pause (1.0) which signify that the thought to be revealed by the client is of crucial significance in her experience. The metaphor of armor pertinently describes the clients’ reservations as to whether she deserves any affection and is semantically tied to the material that precedes it. The involved and client-attuned therapist instantly recognizes the importance of the metaphor and provides a comforting explanation, as demonstrated in the next example:
1 C >I don’t know<, I don’t think I would like that, I don’t like that, people make that sound like a
2 wonderful ↑thing but I couldn’t do that, (1.0) you know (1.0) >like a one night stand<, I need
3 to know a little bit about somebody, are they a good↑ person=
4 T = you sound romantic to me.
You know signifies that something important is about to be produced
by the client. Similarly to extract 1, the long awaited reference to what the
client means by that (i.e. one night stand) is also accompanied by
a pause adding to the significance of the verbalized thought. Client’s
apprehension in defining what is meant by that is further transferred
on the actual verbalized thought as it is spoken very quickly. The therapist
again aptly identifies the emotional load of the information hedged by you
know by providing a latched comment.
In both examples the clients disclose very private, potentially threatening yet intimacy building material that is hedged with you know and relevant pauses. This DM in a way mitigates the upcoming new, often firstly publicly divulged personal views. You know as a ‘mitigator’ seems to be a necessary strategy for the client to protect his or her face in the context of revealed intimate material. As Tannen (1989) observes telling the details creates intimacy. What is important in the use of the first type of you know is the interactional position of the therapist whose comments validate what follows the discourse marker, regardless of how shocking the revealed material might be. In another example you know builds intimacy by making an appeal to be understood and creating the salience of the information it frames:
1 C well,(1.0) when we’re in a really difficult phase and I >wanna< say to her ‘is there anything
2 else I can do?, can I do something to make it more bearable’, she says: no::, just stop, just carry
3 on being, you know (2.0)
4 T what happens inside of you when she says it?=
5 C = >I want to be worth it<, My head knows this, my head knows I can’t take the pain, the
6 humiliation, the depreciation that she is going through, which I WANT TO, I WANT TO, you
7 know, I (0.5) can’t.
Although in the above example the investigated DM follows the revealed intimate material, you know points to the salience of what has been communicated by the client. Again, the therapist’s responses to the emotional aspect of self-disclosure underline his presence and involvement in what is being verbalized. The therapist’s reactions to what either precedes or follows you know index this discourse marker as an intimacy-building strategy. In sum, the first type of you know mitigates the threat posed to the client by verbalizing highly intimate information and at the same time builds intimacy, which characterizes the discourse of psychotherapy. It needs to be observed that you know in the above discussed examples appears to be a grammatically optional element, yet its interactional value in fostering the clients’ confessions cannot be underestimated.
You know triggering verbalization
The second type of you know found in the corpus of psychotherapy
sessions does not function merely as a discourse marker (i.e. as a propositionally
optional element), but its presence in the verbal performance of a client may
lead to the verbalization of the previously ‘unexpressed’. Here,
the therapist’s verbal contribution and conversational work is indispensable
for you know to act as a verbalization trigger. The analyzed material
demonstrates two interactional patterns in which the client utilizes you
know or its variant form I don’t know and the therapist
follows with verbalization-triggering contributions (No, I don’t
know + what , what don’t you know?), which function
as the second element of the adjacency pair:
C: ...,you know.
T: No, I don’t know + (WHAT)
C: VERBALIZED MATERIAL
C: …, I don’t know
T: what don’t you know?
C: VERBALIZED MATERIAL
The above observed patterns of the use of you know starkly contrast
with the type one you know discussed above in the paper,
as here this DM is responded to by the therapist and prompts
the client to express the traumatic, highly private experience. In the first
type of you know, the therapist’s response underscores his attunement
and presence to what the client is saying.
The therapist’s attunement to what the client is trying to communicate enables him to recognize that the client’s use of you know hides quite harrowing aspects of life scripts that need to be self-disclosed in order to become manifest material. This manifest material can then be further worked on by both therapist and client. Here is an example of how you know conceals some distressing experience. The client’s “you know” is followed by the therapist’s response “no, I don’t know” + “what” which leads to the client’s further verbalized material:
1 T: And did you reveal any of your vulnerabilities?=
2 C =No.
3 T How did you make sure that in the army you didn’t reveal any of your vulnerabilities?
4 C You blend↑ in, become ↑ invisible, you don’t ↑ speak, don’t show any anxiety, don’t ever fear,
5 swear, >don’t drink<, (1.0) you know (1.0)
6 T No, I don’t know, train me.
7 C >oh<, you have to be clear what kind of people you need to align yourself with (1.0) and
8 people you need to avoid so:: basically shut up and don’t reveal anything or you’re co::nstantly
In example four, the therapist is involved with the client in the therapeutic inquiry about the client’s problems in integrating with the group and finding a sense of belonging. At this point the inquiry revolves around the client’s experience of being in the army, which as expected, turned out to be quite an excruciating experience. In describing his ways of survival in the army, the client provides a list of “do’s” and “don’ts”. The marked rising intonation on some of the enumerated elements denotes that these are merely some headings which could be further expanded on. The list terminates with you know, which implies to the therapist that behind this discourse marker there is much more that needs to be verbalized. For the client, however, its function might only be indexical of newly disclosed emotionally significant material. Yet, this function is rejected by the therapist who redefines its role by stating ‘no, I don’t know’, and in this way tries to elicit more therapeutically relevant material (cf. Hutchby 2002). Why does it constitute a redefinition of the function of the investigated discourse marker? If you know functions as an element of high involvement style then it is not responded to cognitively. The therapist’s cognitive response, indicating potential lack of knowledge or experience in this area, triggers verbalization as the client starts elaborating on his disturbing experience. The client’s elaboration starts with the so-called initial response token (oh) which as explicated by Jefferson (1988: 428) can mark “serial shifting from distance to intimacy”. The discussed example reveals how oh marks the beginning of further verbalization of the ‘unexpressed’. One element of the verbalized experience, namely the fact of being constantly criticized becomes then one of the core issues that the therapist and client work on in this particular session. The 5th extract features a similar strategy wherein the client’s “you know” is responded to by therapist with “no, I don’t know” which leads to further verbalization:
1 T Go ahead, you were saying?
2 C No::, then I think if I actually saw someone really do something that would impress me, you
3 know (1.0)
4 T No, I don’t know.
5 C >Oh<, if it was really reaching out, it would be easier not to reach out, the cynical voice sort of
6 says (0.5) but when it’s really recognizable pain and >kind of< doing something really useful,
7 practical about it, reaching out to this person. I think there is no question that there is real
8 genuine content as opposed to put on, >pretend<. I know there is a part of me that always says
9 ‘pretend’, ‘put on’.
The therapist considers the client’s you know to
be ‘therapeutically incomplete’ and that there
is more material behind you know that needs to be released. In order
to bring it out, the therapist rejects the function of you know as
an involvement strategy and provides a cognitive response to it, stressing
the negative don’t, which in turn triggers verbalization. In
the verbalized material, opening with the initial response token oh,
the client expands on the theme of ‘pretending’, which is further
advanced in the course of the session. The therapist’s response in the
5th extract slightly differs from the 4th extract as he does not
specify what needs to be identified or focused on, yet in this way the agency
of the client is maintained as he is given a choice as what needs to be further
In the second identified pattern of the use of you know and its variants leading to verbalization, the client makes use of the phrase I don’t know. Gerhardt and Stinson (1995:625) concluded that a client’s I don’t know functions as “part of the patient’s involvement in the reflexive task of self-investigation”. Hutchby (2002) provides a detailed overview of the phrase concluding that “it is not necessarily, and certainly not only, a report on the mental ‘state’ of lacking knowledge”. Rather, considered within the context of talk-in-interaction, it has to be analyzed for the kinds of interactional work it is doing in the sequential places in which it is produced” (2002: 4) . Therefore in line with Hutchby’s postulation, what is the interactional work performed by ‘I don’t know’ phrase in the context of psychotherapy sessions? At first glance it seems that ‘I don’t know’ is applied by the clients for the effect discussed by Potter (1996) that is to “inoculate the speaker against possibly negative inferences that might be drawn on the basis of what has been said” (Hutchby 2002: 150). Let us analyze the following example wherein the client’s “I don’t know” is followed by the therapist’s “What don’t you know?” which leads to further verbalization:
1 C Wh (h)en I see th (h) em going cr (h)azy, you know, when my mother would go crazy, she was 2 crazy ALL THE TIME, >it wasn’t like she could take her time off<, I >mean< I understand
3 people are healthy and giving themselves permission, but still seeing ↑craziness is (0.5) is (0.5) 4 scary, you know, (1.0) what if I say the wrong thing, I don’t know. (1.0)
5 T What don’t you know?
6 C I don’t know how to handle it. >I feel like< I wanna fight it back and get myself in real trouble…
‘I don’t know’ closes the client’s intimate self-disclosure. Gerhardt and Stinson (1995: 625) demonstrated that I don’t know tends to occur at moments of elaboration and self-disclosure on the client’s part, although the phrase looks like a disavowal of what has just been revealed. At the same time its function may overlap with the one proposed by Potter (1996). Both of these interpretations would be applicable if it wasn’t for the upcoming therapist’s contribution. This cognitive contribution (‘what don’t you know?’) as a response to ‘I don’t know’ elicits more talk, i.e. verbalization from the client. It also changes the focus of the client’s talk as he becomes the subject by giving voice to his real anxiety and concerns. Consequently, it can be claimed that ‘what don’t you know?’ takes on a cognitive meaning triggering verbalization of the yet ‘unexpressed’ from the client. In extracts 4, 5 and 6, the clients’ you know or I don’t know are sequentially placed at the end of the information units and there is no further verbal material the follows them . A therapist’s response to the clients’ you know or I don’t know are marked strategies in the context of psychotherapy sessions as these phrases tend not to function as markers of high-involvement style. A therapist’s response (no, I don’t know; what don’t you know?) functions as requests for specification or (further) elaboration on what the client has revealed so far. Thus while the clients produce you know or I don’t know as non-referential, non-cognitive entities, the therapist approaches them cognitively in order to bring out therapeutically relevant material from the client. This material can then be critically approached in joint effort by the therapist and client in order to facilitate the client’s self-transformation. In sum, it can be claimed that the adjacency pairs of: you know – no, I don’t know and I don’t know-what don’t you know? are performative in the sense that they trigger more self-disclosure of the manifest material which is, most importantly, worked on by both parties (the therapist and the client).
Repetitions triggering verbalization
Another strategy used by therapist to foster self-expression is the use of
repetitions. Tannen (1989) distinguishes between four functions of repetition
in a conversation such as: production, comprehension, connection and interaction.
The last function indicates the importance of repetition at the interactional
level of talk where it may accomplish social goals pursued in a conversation
or help to manage the business of conversation. Tannen (1989) further divides
repetition into self-repetition and allo-repetition (the repetition of others).
Furthermore, she places instances of repetition on a continuum ranging from
exact repetition to paraphrase.
The abundant examples of repetition found in the psychotherapy corpus, except for the unmarked functions in production and comprehension of discourse, play a very important role in creating interpersonal involvement (the function of connection) which in turn leads to client’s self-disclosure. The analyzed instances of repetition exemplify the so-called synchronic repetition .
Repetition in the context of psychotherapy session, leading to the client’s verbalization of distressing experience or knowledge, is therapist-generated (cf. the concept of mirroring, Ferrara 1994). An attuned and involved therapist selects a certain word or a phrase from the client’s statement and repeats it:
1 C >yeah, sure<, there are 2 of them, one is like, keeps asking me, you know, I’m your
2 superman and for the first time I answered yes, but when it’s an endless question I
3 say: what do you want from me? or I don’t answer; (0.3) it’s my father, very sad,
4 depressed alcoholic and the other one is like uhm, (2.0) just a fake.
5 T ↑ a fake
6 C yeah, like this guy,> you know<, just that comes to my mind, somebody wearing the
7 clothes of a superman but you know exactly that he is not a superman, it’s just
In the above example the client is talking about the great disappointment of not having a good father-daughter relationship in her life and its grave consequences on her adulthood. This emotionally charged disclosure ends with the word fake. It is however, carefully hedged by uhm and just and a two second pause between them. The word (fake) is then picked up by the therapist and repeated with rising intonation. Bolinger (1982) suggested that rising intonation is a signal that the information unit has not been completed. Consequently therapist’s repetition can be construed as an indirect appeal for the explanation of the word, yet not in terms of its semantic content but, more importantly what it signifies to the client. As a result, the client continues with the personal elaboration on what being a fake entails. The personal elaboration constitutes another example of the verbalization of the previously unexpressed. In another example the therapist comments on the client’s visible sadness. This comment is followed with the client’s remark which is then repeated by the therapist and followed with the client’s verbalization:
1 C Do I always look sad? Does it show so much?
2 T NO, not when you’re dealing with something, (0.2) but you were sitting here, and there was
3 sadness in your eyes. “Does it show so much?” >No<, most of the time you’re smiling and
4 looking very pleasant but I’ve been observing your eyes and there was sadness (2.0) there
5 seemed to be like a secret sadness
6 C >uh huh<, it can get quite extreme
8 T ↑ extreme sadness
9 C yes, I had very long periods of very strong depression and that takes us to the first thing I
10 mentioned to you on the first day.
The therapist’s initial turn ending with a very personal observation of the client’s secret sadness receives only minor expansion from the client. The additional qualifier of the sadness (extreme) is picked by the therapist. The repeated phrase extreme sadness, again with rising intonation, encourages the client to personalize this concept thus verbalize the emotional states embedded in the phrase. The repetition plays a very significant interactional role as the client continues disclosing therapeutically relevant issues. The instance of repetition exemplified above also constitutes the case of collaborative production of talk since the word extreme has been originally uttered by the client and the word sadness by the therapist, who then combines these two and uses the phrase as a verbalization trigger. Such collaborative production contributes to creating a connection between talk participants. Sacks (1995) proved that through collaboratively completing another person’s sentence, interlocutors: “have a way of proving to the person they’re talking with that they’re hearing and understanding what he’s saying” (58). Although in the above instance neither therapist nor client complete each other’s statements, they collaboratively construct the act of verbalization. In example 9 the therapist summarizes the experience presented by the client, which is elaborated on with his and I should not exist. This painful one sentence confession is then repeated by the therapist. This time, however, there is no rising intonation assigned to the repetition, yet it still triggers verbalization from the client:
1 T So the script does not only say “there is still something wrong with me” but also “
2 something is wrong with me and I don’t matter”=
3 C =And I should not exist
5 T And I should not exist.
7 C Everyone else is more important, everyone else’s needs are more important…
In example 9, the therapist provides an immediate and concise summary of what the client has disclosed so far. This summary however is additionally advanced by the client’s and I should not exist. It is vital to underline that this thought has not been previously presented by the client. The therapist recognizes this comment as one that may potentially lead to further verbalization and repeats it. The repetition prompts the client to continue his elaboration on what the script prescribes for him. All the verbalized material through the use of repetition is further approached by the therapist and client working towards a therapeutically relevant outcome, i.e. client’s self-transformation. To conclude, verbalization in the context of psychotherapy can take the direct (priming the pump) or indirect form due to the interactional position of the therapist. Verbalization with the indirect position of a therapist, who relies, to a great extent, on the linguistic performance of a client, can be triggered with the use of you know and repetition.
Verbalization in the context of psychotherapy can also be triggered by a certain
type of inquiry statements made by a therapist. The term ‘statements’ is
intentionally used here as to indicate the character of the inquiry. Although
the inquiring statements are syntactically and prosodically questions, they
do not aim at eliciting one correct answer from the client. On the contrary,
they are applied by the therapist to elicit longer responses to which there
is no one correct answer, but which reveal previously repressed emotional states.
The inquiry takes the form of what’s it like for you +
infinitive. This type of inquiry is better referred to as a process, where
the right type of inquiring statements (i.e. therapeutically-relevant) gradually
leads the client into self-expression.
In extract 10 the therapist, after careful and attentive listening to the client’s story about her marriage, is trying to re-orient her story from factual into more emotional aspect(s):
1 T What’s it like for you, ↓though to have him committed? Is he also committed to that other
2 woman or not?
3 C I asked him first. I knew her, she is not very educated, she only went to school for three years.
4 They live in very low standard, but he is very responsible=
5 T = does he pay the rent ?=
6 C = >yes<, everything, they are dependent on him
7 T // but he keeps them lower class=
8 C = yes, so I can manage this. I have to say I find it just that they are not at the same level.
9 Nevertheless, I have a very good relationship with the children. Th (h) ey come to our h
10 (h)ome, we make excu (h)rsions, we go to lunch together on Sundays and >last month<
11 T // and
12 in your heart? You were talking about your behavior. What’s your heart like with these children?
13 C (2.0) I’m very hurt, I can manage. I can take very many things and my intelligence says it’s the
14 best thing that you can do, but my heart is not in this project.
The re-orientation from a factual account into an emotional account is initiated with the therapist’s what’s it like for you? Yet, it is the therapist’s following comment of the factual nature that is picked by the client who continues with elaboration on how she made the best of the worst situation. The client’s report also indicates her loss of agency in the presented situation. This sense of agency can be reclaimed once she tackles the emotional aspect of this experience. Since the client does not make any interactional move to open up the emotional sphere but continues with the factual account, the therapist interrupts and inserts the re-orienting statement. This statement triggers the client’s verbalization of her emotional attitude to the situation. The verbalization clearly marks an abyss between the client’s intellectual acceptance of the situation and her emotional rejection of the circumstances. All of the instances of ‘you’-oriented inquiry in the corpus play two therapeutic functions. One of them is an attempt to redirect the client’s factual account of the troublesome situation toward a more emotional one. This emotional account constitutes verbalization of the previously unexpressed. Equally important, this verbalization also reclaims the client’s agency as his or her purposefully hidden disappointments, needs and expectations finally resurface. In this type of inquiry the therapist shifts the focus of the client from others on to him or her. The client’s experience, needs and emotional states become the topic of discussion. This emotional verbalization may in turn lead to self-transformation thus a better life. Erskine et al. (1999) state that this kind of inquiry into the unobservable but phenomenogically experienced process of the other person is absolutely unique to psychotherapy.
The conducted analysis evinced therapist’s fundamental role in promoting a client’s verbalization of troublesome aspect of self. It has been shown how a therapist’s response to discourse markers, the use of repetition as well as ‘you’-oriented inquiry lead to a client’s verbalization. In other words, the analysis exemplified how the methods (and values) of Integrative Psychotherapy (e.g. inquiry, attunement, involvement), as represented and adopted by the therapist, take on the verbal forms of context-specific strategies which, in turn, lead to the client’s verbalization. The above discussed strategies promoting the client’s self-expression, i.e. the therapist’s reading of the client’s you know, the therapist’s use of I don’t know, repetitions as well as ‘you’-oriented inquiries comprise representative examples of therapeutic functions of language. These functions, however, are not pre-ordained but interactionally achieved, i.e. their therapeutic value rests on the therapist’s careful reading of the client’s current communicative input including both verbal (language and prosody) and non-verbal aspects. At the same time, as discussed above, verbalization of the client’s experience is the effect of joint interactional effort of both parties as the therapist in eliciting verbalization greatly relies on the client’s verbal (and often non-verbal) input. In other words, we hope to have demonstrated how verbalization, as one of the most important aspects of psychotherapy, is a joint social practice (cf. Antaki et al. 2004:1). The conducted analysis has also corroborated how the same language form can perform different interactional work. In line with this conclusion, it might be that in some other context or form of psychotherapy the therapist’s I don’t know will not elicit any therapeutically relevant material from a resistant client. Thus therapeutic value of certain language forms or communicative strategies is only interactionally created by the involved therapist and client, willing to enter a challenging process of giving up the constricting life script. In phenomenological inquiry, the therapeutic end (verbalization) is achieved through context-sensitive use of language. It is important to stress that phenomenological inquiry is a process through which the client gradually reveals previously unexpressed thoughts, emotions, fantasies and memories. This process of inquiry into the unobservable is conducted by the therapist for the client in order for him/her to self-inspect. It is a chance for the client to give voice to the unexpressed material in the company of a respectful and sensitive individual and an opportunity to begin self-transformation leading to a better life. To refer to Levinson (1983) once verbalization of the troublesome experience has taken place “the world has changed in substantial ways” (228).
- This can be referred to as the expressive meaning of you know.
- Freed and Greenwood (1996) adopted for this study a discourse-based analysis to investigate the frequency of the use of you know in order to account for the potential quantitative difference in the use of this DM between men and women.
- Hutchby (2002: 151) observes that tag-positioned ‘I don’t know’ is different from the same utterance’s use in a stand-alone turn, such as for example a response to a question or invitation.
- This is in line with one of the premises of Conversational Analysis where the meaning of an utterance is narrowed down by its sequential location.
- Synchronic repetition refers to recurrence of words and collocations of words in the same discourse, diachronic repetition, on the other hand, is concerned with the recurrence of words in discourse at a later time (Tannen 1989). Both types of repetition tend to occur in classical psychoanalytic session (cf. Vehviläinen 2003).
.? – punctuation for intonation
↑ - rising intonation, ‘intonation spike’
↓ - falling intonation
:: - elongation of the sound
(3) - timing in seconds
SHE - capital letters to indicate higher volume
Here – increase in volume or emphasis
>here< - inward arrowheads indicate that the word is spoken fast
(h) – laugher particles embedded in the rush of talk
// - interruption
= - equal signs indicate the so-called latch. i.e. neither gap nor overlap in talk
Antaki, Ch., R. Barnes and Leudar, I. (2005). Diagnostic formulations in psychotherapy. Discourse
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