Talking and Cure – What’s Really Going On in Psychotherapy

Leading authors in psychotherapy research pointed to a crisis in psychotherapy process research. There is the equivalence paradox – very different, sometimes contradictory processes lead to a comparable outcome, whose strengths of effects are considered as sufficient. Process analyses use abstract concepts to map larger segments, whereby important details of therapist-patient interaction are overlooked. In spite of the equivalence paradox, there is a strong belief that “techniques only” produce outcome as new coding schemes for therapeutic interventions are being produced. This focus on therapeutic techniques is countered by humanistic traditions and empirical research suggesting that it is, after all, the therapeutic relation alone that produces the healing. The task for future research is to bring technique and relationship together – in conversation.

In spite of the long history of psychotherapy research, we still know relatively little about what actually happens in the therapeutic consultation room. Conversation analysis (CA) offers avenues for the qualitative investigation of the use of therapeutic techniques in context – in momentarily changing interactional situations, rather than treating techniques as fixed independent ‘variables’. Likewise, CA makes it possible to investigate the moment-by-moment unfolding of the therapeutic relationship, rather than treating the relationship as a stable factor contributing to healing.

Conversation is at the heart of psychotherapy. Conversation has the power to integrate technique and relationship in a process of meaning-making, dynamizing a frozen biography, shifting a view, altering conceptions, making new metaphors emerge for a person’s identity or achieving higher levels of reflective functioning or deeper insights. These are the processes that wait to be investigated using CA. Analysis of conversation originates not in psychology but in social sciences. Meanwhile, many recent studies have taken up CA in the examination of psychotherapeutic interaction, showing its usefulness for studying the processes of change in therapy.

The research topic “Talking and Cure” invites researchers in linguistics, social science, and psychology to investigate conversation at the heart of psychotherapy. CA focuses on the rich details what is said and done in interaction -- less “why” people say and do something, but rather the “how” and “when” of what they do and say. It investigates the interactional timing of actions, their linguistic and kinetic design, as well as their consequences in the flow of interaction. Conversation analysis has a profound interest in how people create and maintain shared understandings, how they understand each others’ actions, intentions, and experiences, and acknowledge each others’ emotions. Thus, it should be possible to use this powerful tool in detailed research of therapeutic conversation and to better understand the equivalence paradox, the multiplicity of theoretical orientations and the splitting of “techniques” vs. “relational analyses”. Researchers who find this a promising goal are invited to contribute.