Dialogic Discourse Analysis of Psychotherapeutic Dialogue: Microanalysis of Relevant Psychotherapy Episodes

This paper shows a microanalysis of episodes of therapeutic change and ruptures of the alliance using Dialogic Discourse Analysis as a method that makes it possible to detect discursive strategies in psychotherapeutic dialogue. Four relevant episodes, two of therapeutic change and two of ruptures of the alliance, from different sessions of a long-term psychoanalytic psychotherapy were analyzed using a qualitative methodology. Results showed linguistic features of change and rupture. In the latter, linguistic markers were identified, which highlighted the connection between the rupture of the alliance, its resolution, and change. The use and advantages of this microanalytic method are discussed. Keywords: Dialogic discourse analysis, microanalysis, psychotherapy process research To see a World in a grain of sand and a heaven in a wild flower Hold infinity in the palm of your hand and eternity in an hour. William Blake (Auguries of Innocence, 1800-1803/1863) Process research in psychotherapy focuses on the phenomenon of change in the context of therapeutic interaction. Studies based on this approach have shown that, rather than being a homogeneous process, psychotherapy is made up by a series of segments, periods, or phases whose causal and temporal relations tend to be complex, and not necessarily linear (Krause, 2005; Orlinsky, Helge & Willutzki, 2004). Besides, as a result of such a heterogeneous notion of the process of psychotherapeutic change, researchers have centered their efforts on identifying relevant episodes leading to the construction of psychic change (Greenberg, 2007; AUTHORS’ NOTE. Please address all correspondence regarding this article to Claudio Martínez Guzmán, Psychology Faculty, Universidad Diego Portales, Vergara 275, Santiago, Chile. Email: [email protected] MARTÍNEZ, TOMICIC, & MEDINA 100 Krause, 2005; Orlinsky, Helge & Willutzki, 2004). This is grounded on a theoretical framework about what change is and what non-change is in this specific context (e.g. Gonçalves, Matos, & Santos, 2009; Krause, et al., 2007). This study specifically deals with episodes of change and episodes of ruptures of the therapeutic alliance. A change episode is an interaction segment in a psychotherapeutic session in which a representational-level change is observed in the patient. The method for determining change episodes, derived from this definition, is based on the notion of generic change of subjective theories (Krause, 2005; Krause et al., 2007). Therefore, an episode of change is an interaction segment where a patient’s microchange takes place and corresponds with some generic change indicator. In the rating procedure to demarcate a change episode, this microchange moment is used to mark the end of the episode. From this point, and according to a thematic approach, a rater reviews the text of the session backward in order to identify the beginning of the topic discussed by the patient and the therapist that deals with that specific microchange moment (Krause et al., 2006; Valdés et al, 2010). Several studies have shown that utterances belonging to a moment of change are characterized by the use of the first person singular, the present tense, and the presence of self-referential content (Aristegui et al, 2004; Reyes et al., 2008; Stiles, 1992). This has been interpreted as the patient being the protagonist and author of his or her own change. For instance, in a moment of change, the patient is expected to express this change verbally with an utterance which includes something like "now, I, about myself". From a dialogic perspective, this linguistic construction connects "who speaks" (subject of enunciation) with "who is in charge" of what is being talked about (subject of the utterance). Such a linguistic construction is a position of the self which establishes his/her authorship of utterance (Bakhtin, 1986). At this point, a question to ask is: how does therapist patient dialogue help cement the patient's authorship of his/her own change? Here the aim was to explore, in episodes of therapeutic change, specific verbal interaction performed by the participants for the patient to be the author of his or her own change. With regard to episodes of rupture, following Safran & Muran (1996, 2000, 2006) we will understand these “processes of rupture” of the therapeutic alliance as a disruption in the process of intersubjective negotiation. That is, as ruptures in patienttherapist communication which manifest themselves through two thematic, behavioral, 1 The notion of microchange makes reference to a level of analysis, specifically a microscopic level. This level refers to the immediate consequences of therapeutic intervention. In this level, if the analysis focuses on the outcome, then in-­‐session impacts or microchanges are studied. If the analysis focuses on the process, then moment-­‐by-­‐moment or microanalytic strategies are performed (Orlinsky, Helge, & Willutzki, 2004). This study integrates both approaches. DIALOGUE DISCOURSE ANALYSIS 101 and communicational markers: a) Withdrawal or distancing, and b) Confrontation. Both markers reflect the ways in which each member of the dyad approaches the tension between self-regulation and mutual regulation in the intersubjective field -that of interactive regulation-. An optimal level of regulation is a balance between selfregulation and mutual regulation, with the middle range resulting in the most satisfactory degree of flexibility between both dimensions of the interaction. If mutual regulation is interrupted, participants will focus their attention on their own regulation and neglect their mutual link (Beebe, 2006). In spite of this temporary rupture in communicative negotiation, the tension becomes–according to Safran & Muran (2006)–the intersubjective field for the construction of change. A question that comes up at this point is how does the therapistpatient dialogue configure the development and resolution of an episode of rupture of the alliance? Here the aim was to explore, in episodes of rupture of the therapeutic alliance, specific verbal interaction performed by the therapist to reestablish the relationship. In order to sketch an answer for these questions about episodes of change and ruptures, we have chosen to use a microanalysis method based on the contributions of the dialogic perspective of discourse analysis (Bakhtin, 1986; Hermans, 1996; Holquist, 1990). There is a small body of literature about discourse analysis or conversational analysis in psychotherapeutic dialogue (e.g., Antaki, Barnes, & Leudar, 2005; Gunn, 2004; Peräkylä, 2004). The dialogic perspective contributes to this line of research by studying a therapeutic process focusing mainly on the relationship between the self and the other (alter). In this study, we will consider the self as fundamentally dialogic: as a relationship between a self and an alter (Hermans & Lyddon, 2006, Marková, 2006). In psychotherapy, this other is thought to have at least two levels. It is a therapist (or patient) other with whom the patient (or therapist) establishes a real dialogue and, at the same time, multiple and diverse others which are present in the discourse of both participants (Marková, 2006). These others are a part of the self, but their presence in the narrative structure of the self is vivid as if they were other people, imaginal figures (Hermans, Rijks, & Kempem, 1993) who keep different positions or perspectives regarding the same situation. Any dyad taking part in a dialogue, including the therapeutic dyad, is mutually responsible for the multiple meanings of such dialogue, and of being the addressee of each other's meanings, including the others who are not physically present, but who are referred to in the dialogue. From this perspective, we will differentiate two dimensions in the psychotherapeutic dialogue. One of them refers to the real dialogue between the participants involving the rules pertaining to conversation, which we will call dialogal exchange. The other dimension, which takes into account the dialogue established between the multiple voices or positions that the I adopts in the self and that manifest themselves in the discourse of each of the participants, will be referred to as dialogic MARTÍNEZ, TOMICIC, & MEDINA 102 exchange (Grossen & Salazar, 2006). For example, Dimaggio and collaborators (Dimaggio, Salvatore, Azzaras & Catania, 2003; Dimaggio, Fiore, Salvatore & Carcione, 2007) have conceptualized this internal dialogue between the patient's positions as dialogical relationship patterns, stressing the idea that these patterns constitute the building blocks of personality. The first dimension of dialogue, or dialogal exchange, is analyzed by means of Conversational Analysis (CA) tools that enable us to illustrate real patient-therapist exchanges (for an example, refer to Forrester & Reason, 2006, or Peräkylä, 2004) ). The second dimension, the dialogic exchange, is analyzed via a microanalysis system that seeks to mark this multivocity and its influence on the construction of shared meanings (intersubjectivity) in a linguistic manner. Both analytical tools are part of the Dialogic Discourse Analysis (DDA) method (Larraín & Medina, 2007, Martínez & Medina, 2009), a form of discourse analysis based on Bakhtin's ideas about dialogism, and which sees discourse as permanently marked by subjectivity (Larraín & Medina, 2007). The purpose of this paper is to present this microanalytic method applied in an ongoing study about dialogical regulation in psychotherapeutic dialogue. Specifically, its aims are to show the use of DDA as a productive microanalysis strategy in the evaluation of relevant psychotherapy episodes, and to illustrate the application of DDA in two episodes of change and two episodes of rupture of the therapeutic alliance. In order to illustrate the DDA method, we propose two objectives. As mentioned above, they were: first, in episodes of therapeutic change, to explore specific verbal interaction performed by the participants for the patient to be the author of his or her own change; and second, in episodes of rupture of the therapeutic alliance, to explore specific verbal interaction performed by the therapist to reestablish the relationship.