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Discourses of Helping Professions

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Pragmatics & Beyond New Series (P&BNS) Pragmatics & Beyond New Series is a continuation of Pragmatics & Beyond and its Companion Series. The New Series offers a selection of high quality work covering the full richness of Pragmatics as an interdisciplinary field, within language sciences. For an overview of all books published in this series, please see http://benjamins.com/catalog/pbns

Editor

Associate Editor

Anita Fetzer

Andreas H. Jucker

University of Augsburg

University of Zurich

Founding Editors Jacob L. Mey

Herman Parret

University of Southern Denmark

Belgian National Science Foundation, Universities of Louvain and Antwerp

Jef Verschueren Belgian National Science Foundation, University of Antwerp

Editorial Board Robyn Carston

Sachiko Ide

Deborah Schiffrin

Thorstein Fretheim

Kuniyoshi Kataoka

University of Trondheim

Aichi University

Paul Osamu Takahara

John C. Heritage

Miriam A. Locher

University College London

Japan Women’s University

University of California at Los Angeles

Universität Basel

Susan C. Herring

Indiana University

Masako K. Hiraga

St. Paul’s (Rikkyo) University

Georgetown University Kobe City University of Foreign Studies

Sandra A. Thompson

Sophia S.A. Marmaridou University of Athens

University of California at Santa Barbara

Srikant Sarangi

Teun A. van Dijk

Cardiff University

Marina Sbisà

University of Trieste

Universitat Pompeu Fabra, Barcelona

Yunxia Zhu

The University of Queensland

Volume 252



Discourses of Helping Professions Edited by Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy

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Discourses of Helping Professions Edited by

Eva-Maria Graf Klagenfurt University

Marlene Sator Gesundheit Österreich GmbH

Thomas Spranz-Fogasy IDS Mannheim


John Benjamins Publishing Company


Amsterdam / Philadelphia

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The paper used in this publication meets the minimum requirements of the American National Standard for Information Sciences – Permanence of Paper for Printed Library Materials, ansi z39.48-1984.

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Library of Congress Cataloging-in-Publication Data Discourses of helping professions / Edited by Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy. p. cm. (Pragmatics & Beyond New Series, issn 0922-842X ; v. 252) Includes bibliographical references and index. 1. Discourse analysis--Social aspects. 2. Professions--Terminology. 3. Social service-Terminology. 4. Sublanguage. I. Graf, Eva-Maria, editor. II. Sator, Marlene. III. Spranz-Fogasy, Thomas. P305.19.P76D57 2014 158.301’41--dc232014026461 isbn 978 90 272 5657 7 (Hb ; alk. paper) isbn 978 90 272 6943 0 (Eb)

© 2014 – John Benjamins B.V. No part of this book may be reproduced in any form, by print, photoprint, microfilm, or any other means, without written permission from the publisher.



John Benjamins Publishing Co. · P.O. Box 36224 · 1020 me Amsterdam · The Netherlands John Benjamins North America · P.O. Box 27519 · Philadelphia pa 19118-0519 · usa

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Table of contents

Discourses of helping professions: Concepts and contextualization Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy How practitioners deal with their clients’ “off-track” talk Charles Antaki

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Empathic practices in client-centred psychotherapies: Displaying understanding and affiliation with clients Peter Muntigl, Naomi Knight and Ashley Watkins

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The interactional accomplishment of feelings-talk in psychotherapy and executive coaching: Same format, different functions? Eva-Maria Graf and Joanna Pawelczyk

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“Making one’s path while walking with a clear head” – (Re-)constructing clients’ knowledge in the discourse of coaching: Aligning and dis-aligning forms of clients’ participation Marlene Sator and Eva-Maria Graf

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Form, function and particularities of discursive practices in one-on-one supervision in Germany Yasmin Aksu

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“I mean is that right?” Frame ambiguity and troublesome advice-seeking on a radio helpline Ian Hutchby

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Professional roles in a medical telephone helpline Mats Landqvist

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Anticipatory reactions: Patients’ answers to doctors’ questions Thomas Spranz-Fogasy

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Discourses of Helping Professions

“Doctor vs. patient”: Performing medical decision making via communicative negotiations Tim Peters

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Time pressure and digressive speech patterns in doctor-patient consultations: Who is to blame? Florian Menz and Luzia Plansky

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Neurologists’ approaches to making psychosocial attributions in patients with functional neurological symptoms Chiara M. Monzoni and Markus Reuber

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Name index Subject index

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Discourses of helping professions Concepts and contextualization Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy

Discourses of helping professions unites contributions on prominent helping settings and interaction types and offers an overview of similarities and differences as regards interactive affordances and communicative tasks and the discursive practices applied for their solution within and across the various helping professions. Whereas traditional helping professions such as medical and psychotherapeutic communication are by now well-established objects of research in discourse and conversation analysis (see e.g. Byrne and Long 1976; Heritage and Maynard 2006; Spranz-Fogasy 2010; Sator and Spranz-Fogasy 2011 for doctor-patient interaction and Labov and Fanshel 1977; Peräkylä et al. (eds.) 2008; Pawelcyzk 2011 for psychotherapy), so-called developmental formats like supervision or executive coaching have only lately attracted linguistic attention (see Aksu in prep.; Graf et al. 2010; Graf 2012; Graf in prep.). Yet, research on both traditional and less traditional formats revolves around similar questions such as: What represents their endemic communicative core tasks and what is interactants’ discursive repertoire to solve these? A closer look at the various professional practices thereby evinces a highly differentiated and complex picture of these helping professional formats with numerous sub-types, transitions and hybrid formats. A helping profession is defined as a professional interaction between a helping expert and a client, initiated to nurture the growth of, or address the problems of a person’s physical, psychological, intellectual or emotional constitution, including medicine, nursing, psychotherapy, psychological counseling, social work, education or coaching. To speak with Miller and Considine (2009: 405), helping professions deal with “the provision of human and social services”. The helping profession is constituted in and through the particular verbal and non-verbal interaction that transpires between the participants. Interaction types, in turn, are (tentatively) defined here as bounded (parts of) conversations with an inherent structuring of opening, core interaction and closing section, in which participants solve complex communicative tasks. The specific interaction the participants



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Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy

engage in thereby evinces the respective interaction type. To put it differently, the principal communicative task(s) define(s) the overall rationale of the (specific part of the) conversation, i.e. the interaction type. Interaction types are thus both located on the macro-level of interaction, when referring to entire conversations or interactions such as the anamnestic interview and on the meso-level of interaction, when referring to parts of conversations that center on clearly demarcated communicative tasks within the overall layout of the interaction (such as troubles telling in psychotherapy). Although closely related with, and at times hard to differentiate from, neighboring theoretical concepts such as ‘activity type’, we prefer ‘interaction type’ over ‘activity type’ in Levinson’s (1992) and Sarangi’s (2000) sense for its applicability on both the communicative macro and the meso-level. Helping in and through communication as a means to solve an individual’s problem has always been an endemic purpose of human communication and as such is inherent in its formats and characteristics: Especially the goal-orientation of communication, its overall purpose of solving tasks as well as the possibility to add another’s perspective are central elements of helping professions (Kallmeyer 2001; Miller and Considine 2009) and thus experience a fundamental productivity in doctor-patient interaction, psychotherapy, counseling, coaching etc. These basal characteristics form the interactive baseline of helping professions. Socio-cultural and technological developments materialize in relatively recent professional formats such as coaching or telephone hotlines, while an ongoing specification and hybridization of communicative tasks like decision-making materialize in similar, yet format-specific, practices for their solution. Communication is characterized by its constitutivity (i.e. communication is interactively constituted), interactivity (i.e. communication results from the intertwining and mutual coordination of participants’ contributions and perspectives), processuality (i.e. communication evolves over time), pragmaticity (i.e. communication means interactively working on participants’ shared and individual goals) as well as methodicity (i.e. applying socio-culturally shared practices for the communicative solution of common goals) (Deppermann 2008). Constitutivity transpires along a thematic-, identity- and relationship-dimension as well as an activity dimension (Kallmeyer 2005; see Sarangi 2000 for a related distribution into thematic, interactive, and structural dimension): Whereas participants co-construct a topic as ‘primary concern’, ‘complaint’ etc. on the thematic level, they co-construct their respective social roles and relationships as e.g. ‘doctor-patient’, ‘therapist-client’ etc. and finally, they apply and agree on particular activity formats to work on the primary concern, the complaint etc. In our post-modern world of increasing fragmentation, diversification and specialization of knowledge, the above mentioned implications and potentials of interaction result in a growing number of (communication) experts such as doctors, therapists, supervisors or



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Discourses of helping professions: Concepts and contextualization

coaches and in growing affordances as regards their professionalization. Whereas helping interaction was originally understood to solve social and individual problems of a medical or psychological nature, it has become increasingly relevant for communication-intensive professions such as therapy, teaching etc., where counseling supervision helps professional communicators to reflect on their own professional communication with their clients. That is, helping professionals support other helping professionals in their respective communicative interaction with their clients, patients, customers. Another, more recent site of helping interaction is the larger organizational context of human resource development, where professional communicators support their clients in self-development and -reflection, optimizing managerial skills or eliciting peak performance for their own sake and the sake of the organization. The individual and his or her physical, psychological, emotional, professional or intellectual needs are thereby always embedded in some kind of institutional context. Besides communicative support on the individual level, the ongoing social differentiation and repartition of knowledge leads to a growing need for external professional support on the organizational level, too. However, the focus here is on helping interaction on the individual, not the organizational level as is found e.g. in management consulting (see e.g. Habscheid 2003). Whereas the book’s larger framework builds on the analogy between helping interaction and the basal characteristics of communication, the more specific framework zooms in on the similarities, differences and interferences within and across the various helping professional interaction types and their overall purpose of communicatively tackling a patient or a client’s physical, psychological, emotional, professional or managerial concern. The edited volume thereby adds the following two aspects to the analysis of professional interaction: Besides Sarangi and Roberts (eds.) (1999), it is the first discourse analytic book specifically dedicated to helping professions as its overarching thematic focus. Alongside research focusing on institutional discourse (see Drew and Heritage (eds.) 1992; Arminen 2005), professional discourse (see Gunnarson et al. 1997; Candlin (ed.) 2002), language and communication in organizations (see Candlin and Sarangi (eds.) 2011) or workplace discourse (see Koester 2010), and research with a specific helping professional focus such as language and health communication (Hamilton and Chou (eds.) 2014), it adds to our general understanding of helping professions and their particular communicative and interactive characteristics. Such insight is particularly relevant in sight of the omnipresence and socio-cultural importance of helping professions in late modern society as part of the expert-system in our therapeutic culture (Giddens 1991; Furedi 2004). The second innovative aspect lies in the inter-professional perspective. Up to this point, various helping settings and interaction types have been analyzed

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intra-professionally in their own right, i.e. within their respective professional boundaries (see e.g. Neises et al. 2005; Heritage and Maynard 2006; Nowak and Spranz-Fogasy 2009 for the medical context, Peräkylä 1995; Muntigl 2004 and Hutchby 2007 on various types of counseling and e.g. Labov and Fanshel 1977; Peräkylä et al. 2008 and Pawelcyzk 2011 for the therapeutic context). One strand of research has thereby focused on the internal diversity and gradual morphology of e.g. medical interaction or therapeutic interaction (see e.g. Ruusuvuori 2005 on the difference between homeopathic and GP consultations in the case of problem presentation). Yet, the recurrence of particular interaction types or discursive practices across different helping professions has not been at the center of discourse-analytic attention on a larger scale (for individual projects see e.g. Pawelczyk and Graf 2011 on stereotypical feminine strategies as agents of change in psychotherapy and coaching and Pick et al. (in prep.) on the interactive characteristics of initial sequences in legal consultation, supervision and executive coaching). Although the overlap and reappearance of particular discursive practices has been acknowledged for institutional and professional interaction in general (cf. Drew and Heritage 1992: 27; Sarangi 2004: 6), the possible sharing of interaction types as well as its local and global consequences has so far not been addressed in the context of helping professions. The attested fluctuation and recurrence of particular interaction types across helping professions must be interpreted as a product and consequence of the “plurality and fragmentation of late modern social life” (cf. Chouliaraki and Fairclough 1999: 5). This in itself is of linguistic and interactional nature as the processes of fragmentation and differentiation are constituted in a proliferation of language uses. The purpose of the edited volume is to spark off a theoretical and conceptual discussion on variation and recurrence of communicative tasks and discursive practices in helping professions by focusing on their hybrid character as well as on the gamut of their discursive intra- and inter-variation. Authors from different linguistic, sociological, conversation analytic and helping professional practical backgrounds offer their expertise in medical, psychotherapeutic, supervision and coaching interaction. The contributions are united on the theoretical level by recurring thematic aspects such as empathy and feelings-talk, keeping clients on track in spite of their verbosity or resistance, professional identity and role construction. Another recurring topic is deviation from the professional agenda or other communicative disturbances, findings that offer valuable insight into interactants’ underlying expectation as regards the particular activity format. On the structural level, the contributions are united by aspects such as the relevance of specific sequential positioning of participants’ contribution. As regards data and research methods, all contributions work with authentic data from professional helping interactions (in Peter’s contribution, the data stem from an authentic



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medical training context). Yet, given that the studies were carried out individually in different contexts for different purposes, the data are analyzed with a variety of methods such as CA, applied CA, integrative qualitative analysis or discourse analysis. Due to the same fact, the data are transcribed following different conventions such as Jefferson, GAT2 or HIAT from (slightly) different theoretical backgrounds; these conventions are laid out in the respective references of the individual contributions. Although the practical application of their findings in the various fields of helping professions is not the primary motivation of all contributions, already the more theoretical insight is of practical value: the increasing fragmentation and specification of the helping business results in a growing insecurity on the side of the patients, clients and consumers of helping professional services. A clearer picture of how and where interaction types in helping professions truly differ offers the necessary orientation for those in search of such services (see e.g. Graf and Pawelczyk (this volume) and their comparison of psychotherapy and executive coaching in their respective dealing with feelings-talk). Another relevant practical aspect is the training context of (future) helping professionals: discourse-analytic findings as regards the interactive specifics of their professional doing could and should be integrated in (future) trainings and the respective manuals for doctors, therapists, coaches, counselors etc. This is in accordance with Antaki’s (2011) claim for using conversation analytic findings as forms of intervention and change in institutional talk and is particularly exemplified e.g. in the contributions by Sator and Graf or Menz and Plansky.

Contributions In more detail, the contributions in Discourses of Helping Professions focus on the following discursive practices across helping professional communication: The first chapter by Antaki, How practitioners deal with their clients’ “off-track” talk, addresses professional practices of keeping clients on track from the above mentioned applied conversation analytic perspective: The popular expectation of helping professions is that the client’s troubles and concerns take priority on the floor. On the other hand, professional staff may have other more pressing objectives and priorities. There is then a dilemma. For example, at some point in a psychotherapy session, the therapist may have a specific therapeutic or managerial objective in mind which is to be pursued closely, even at the expense of seeming to be unresponsive to the client’s currently expressed concerns. What is a therapist to do when the client’s talk is not – as the therapist judges – ‘on track’ with the therapeutic agenda? To the degree that psychotherapy texts address the question at all,



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they may be firm in their recommendation that the therapist proceed sensitively. However, as Peräkylä and Vehviläinen (2003) observe about psychotherapy practice, textbooks are not helpful in giving detailed instruction in how therapeutic principles are actually to be embodied in the details of talk. Here, then, is a chance for a close, detailed reading, such as is offered by Conversation Analysis (CA), of the actual recorded practices of therapists and other helping professionals. Based on an inspection of sessions with intellectually impaired and non-impaired clients, seven conversational practices are identified by which staff may keep the session “on-track” in the face of possible deviation. Muntigl, Knight and Watkins’ contribution Empathic practices in client-centred psychotherapy. Displaying understanding and affiliation with clients explores how client-centred empathy is practiced within a specific interaction type: troubles telling sequences. Building on the work of Carl Rogers, who viewed empathy as a form of understanding that privileges the client’s point of view, empathy is examined as an interactional achievement in which clients create empathic opportunities by displaying their affectual stance, followed by therapists taking up these opportunities through affiliative displays. It is found that empathic practices could be realized through a variety of verbal (naming other’s feelings, formulations, co-completions) and non-verbal resources (nodding, smiling). Further, the data evinced that continuers played an important role in helping clients to develop their troubles stance in more detail, which, in turn, invited more explicit empathic displays from therapists. Empathic practices and feelings-talk are also at the centre of the contribution by Graf and Pawelczyk The interactional accomplishment of feelings-talk in psychotherapy and executive coaching – same format, different functions? looks into the forms and functions of feelings-talk in two important ‘helping’ contexts, i.e., psychotherapy and executive coaching. In psychotherapy, the therapist’s elicitation of clients’ experiences of stressful and traumatic events fulfills important functions such as facilitating clients’ new appraisals of the stressful situations. In this sense a psychotherapeutic interaction emerges as a model of performing emotional labor offering multiple modes of communicating emotional experience. As one consequence of the therapeutic culture of late modern society feelings-talk has also entered the managerial realm. Despite the entrepreneurial and business-oriented character of executive coaching, clients’ verbalizations of emotional experience constitute a central element in coaching interaction. By applying an integrative qualitative analysis, Graf and Pawelczyk discuss the particular function of feelings-talk in the two different professional formats and illustrate how this endemic communicative task of therapeutic interaction is adapted to meet managerial affordances in the context of executive coaching.



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The next chapter by Sator and Graf is also dedicated to the relatively recent and under-researched helping profession ‘coaching’. In “Making one’s path while walking with a clear head” – (Re-)Constructing clients’ knowledge in the discourse of coaching: Aligning and dis-aligning forms of clients’ participation, the authors focus on the communicative task of (re-)constructing clients’ knowledge. Knowledge (re-)constructions represent an endemic interactive feature of this helping profession, which aims to solving clients’ business-related concerns via developing concrete solutions for their problems. Besides its solution-orientation, coaching is guided by the professional norm of enabling help for self-help. This action-guiding assumption locates all relevant information in clients’ territory of knowledge and disapproves of strongly directive interventions such as interrupting the client. A dilemma may arise for the professional when clients non-align in constructing a solution given that concrete plans of actions are required, but should be developed co-actively based on clients’ own knowledge. The chapter tackles the interactive consequences of such dis-aligning forms across one coaching session between an apprentice coach and his client by illustrating the coach’s strategies in struggling with his professional dilemma and client’s strategies to resist the professional’s attempts to non-directively keeping her on track. Form, function and particularities of discursive practices in one-on-one supervision in Germany by Aksu extracts discursive practices in supervision, another helping profession that has so far received little discourse analytic attention. Oneon-one supervision in Germany is not always the counseling of a professional in the helping professions by a supervisor from a similar field. It can also be – due to its adaptation to modern work contexts – a counseling format for a professional in a managerial position, not unlike business coaching. In some cases, these two aspects converge. In her analysis, the author describes how two of the ubiquitous communicative tasks in one-on-one supervision (‘establishing the need for counseling, establishing the counselor as authority’ and ‘presenting the problem’) are tackled in light of this convergence and show that supervision is a conversation between experts who create a specific supervisor-supervisee relationship. The next two chapters, “I mean is that right?”: Frame ambiguity and troublesome advice-seeking on a radio helpline by Hutchby and Professional roles in a medical telephone helpline by Landqvist, tackle professional helping interaction that is not realized face-to-face, but mediated via radio and telephone, respectively. Hutchby analyzes the operation of the “expert system” for the provision of advice in the setting of a call-in radio program. He investigates the sequential properties of calls in which the central communicative activity of advice-seeking is merged with another activity, that of troubles-telling. In most calls, advice-seekers (members of the public) succeed in identifying a clear advice topic and advice-givers (the radio host and a social welfare expert) succeed in advising

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on that topic, albeit within the distinctive constraints of the broadcast setting. In a small number of cases, however, there is a difference in that the advice-seeking turns instantiate an ambiguous framing in which it is unclear whether the caller is seeking advice about, or making a complaint about, the social welfare system. This poses a problem for the expert system comprising the show’s host and accredited expert, in terms of how they design the reception of advice-giving turns and the development of subsequent sequences. The author shows how the different speaker identities of caller, host and expert operate in different ways as the expert system responds to the call’s frame ambiguity and seeks to re-invoke the standard features of advice-giving. Landqvist, in turn, addresses the professional roles of medical advisors working in a medical help line. The analysis focuses on calls about the swine flu epidemic in 2009 and analyzes role shifts of the advisors due to changing situations and callers’ needs. This study is mainly instructed by the concept of hybridity as a main characteristic of counseling as an interaction type. Several sub-types, communication tasks such as expert-based problem solving and strategies such as social chatting and joking are identified, all of which are connected to the shifting contexts of call. Tasks and strategies used by the advisors are examined and described as relevant and to some degree typical subtypes in a modern medical help line. Phenomena like hybridity and role shifts are thus viewed as reflections of the context models used and as their updates, and as a necessary trait of an advisor’s professional communicative competence. The last group of four chapters is dedicated to the traditional helping profession ‘doctor-patient interaction’ and adds to our already extensive discourse analytic insight into how doctors and patients communicate with each other within and across medical schools, specializations and settings, by examining patients’ anticipatory reactions in history taking, by zooming in on the doctor-patient relationship, by investigating into reasons for protractions in medical consultation and finally, by showing the hybrid communicative character of neurologists’ making psychosocial attributions in the interaction with patients with functional neurological symptoms. In more detail, Anticipatory Reactions – Patients’ Answers to Doctors’ Questions by Spranz-Fogasy examines patients’ answers to doctors’ questions during history taking as a central activity format which reveal a deeper understanding of each other. An analysis of medical interactions shows that patients mostly expand the topical, structural and/or pragmatic scope of the doctors’ questions. The sequential positioning of answers provides more possibilities than is to be seen from a strict perspective of question types. Patients’ answers reflect their understanding of the current interaction type, and of the question’s implications, doctors’ relevancies as patients assume them, or even the doctors’ presupposed next question; a phenomenon which is called anticipatory reaction. Both action



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formats and their interplay point to two important principles of interaction: the principle of cooperation and the principle of progressivity within the frame of the particular interaction type. Peters’ contribution on “Doctor vs. Patient” – Performing Medical Decision Making Via Communicative Negotiations investigates into how the physician-patient-relationship is initially established in the context of medical decision making. While the relationship is of major concern in linguistics and medical ethics, the theoretical constructs on medical decision making hardly provide insights into how it is discursively constructed. The relationship is not fixed at the beginning of the initial conversation and is continuously negotiated between doctor and patient in the course of the interaction, based on their respective specific ideas and perceptions. The findings of videotaped interactions between medical students and standardized simulated patients indicate that the physician-patient-relationship can be explored in respect of at least three different aspects, namely (1) the conversation structure, (2) the content focus of the dialogue and (3), the process of decision making. A change in one of these aspects – initialized by both conversational partners in using the whole spectrum of multimodal communication – will influence the other ones. By use of different instruments of power in communication, physician and patient negotiate the type of their physician-patient-relationship and thereby determine the mode of decision making. In Time pressure and digressive speech patterns in doctor-patient consultations: Who is to blame? Menz and Plansky ask who is responsible in protracting medical consultation: Medicine, among the oldest and institutionally best developed helping professions in Western societies, finds itself characterized by a number of unique aspects, among which is the increasing fragmentation of the medical sciences which in turn has resulted in the “fragmentation of the patient” (Mishler 1984). One of the most visible forms of fragmentation is the fragmentation of time in medical treatment represented by small time slots and long waits for the patients. In this respect public health service differs significantly from other types of helping professions as executive coaching, psychotherapy or supervision counseling. Physicians frequently blame verbose patients, who cannot easily be prevented from talking, for increasing scheduling problems. This contribution, however, will present some opposing results. On the basis of a quantitative and qualitative analysis of 268 transcribed medical interviews the findings indicate that it is not so much the patients’ psychic structure (“being talkative”) that protracts medical consultations, but rather the physicians’ interactional patterns. For medical education (in particular, and counseling settings in general) these results might be of considerable interest as they counter popular prejudices on patient behavior and might contribute to reshaping the doctor-patient relationship.

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The final chapter by Monzoni and Reuber on Neurologists’ approaches to making psychosocial attributions in patients with functional neurological symptoms zooms in on neurologists’ approaches to making psychosocial attributions in patients with functional neurological symptoms: Doctors perceive consultations with patients with functional neurological symptoms (FNS) as challenging because of the dichotomy between the psychosocial nature of the symptoms and patients’ perceptions that their condition is essentially physical. Through conversation analysis, the authors describe some communicative strategies neurologists employ to make psychosocial attributions, ranging from unilateral to more bilateral approaches. In unilateral approaches doctors employ general explanations about the psychosocial aetiology, thereby pre-empting any potential resistance. In bilateral approaches, doctors actively involve patients in discussing potential psychosocial causes, by also making direct and specific psychosocial attributions. These practices display doctors’ great caution in this communicative task; and they exhibit a hybridization with those employed by psychologists, which might be strictly linked to this type of patients.

References Aksu, Yasmin. in prep. Kontext, Selbstverständnis und Gesprächsrealität der Supervision. Antaki, Charles (ed.). 2011. Applied Conversation Analysis. Intervention and Change in Institutional Talk. Houndmills: Palgrave Macmillan. Arminen, Ilkka. 2005. Institutional Interaction: Studies of Talk at Work. Aldershot: Ashgate Publication. Byrne, Patrick, and Barry Long. 1976. Doctors Talking to Patients: A Study of the Verbal Behavior of General Practitioners Consulting in their Surgeries. London: HSMO, Royal College of General Practitioners. Candlin, Christopher N. (ed.). 2002. Research and Practice in Professional Discourse. Hong Kong: City University of Hong Kong Press. Candlin, Christopher N., and Srikant Sarangi (eds). 2011. Handbook of Communication in Organisations and the Professions. Amsterdam: Mouton de Gruyter. DOI: 10.1515/9783110214222 Chouliaraki, Lilie, and Norman Fairclough. 1999. Discourse in Late Modernity. Rethinking Critical Discourse Analysis. Edinburgh: Edinburgh University Press. Deppermann, Arnulf. 2008. Gespräche analysieren. Eine Einführung. Wiesbaden: VS-Verlag für Sozialwissenschaften. DOI: 10.1007/978-3-531-91973-7 Drew, Paul, and John Heritage (eds). 1992. Talk at Work. Interaction in Institutional Settings. Cambridge: Cambridge University Press. Drew, Paul, and John Heritage. 1992. “Analyzing Talk at Work: an Introduction.” In Talk at work. Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 3–65. Cambridge: Cambridge University Press.



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Furedi, Frank. 2004. Therapy Culture. Cultivating Vulnerability in an Uncertain Age. London: Routledge. Giddens, Anthony. 1991. Modernity and Self-Identity. Self and Society in Late Modern Age. Stanford: Stanford University Press. Graf, Eva-Maria, Yasmin Aksu, and Sabine Rettinger. 2010. “Qualitativ-diskursanalytische Erforschung von Coaching-Gesprächen.” Zeitschrift für Organisationsberatung, Supervision und Coaching 17 (2): 133–149. DOI: 10.1007/s11613-010-0188-7 Graf, Eva-Maria. 2012. “Narratives of Illness and Emotional Distress in Executive Coaching: An Initial Analysis into their Forms and Functions.” Poznań Studies in Contemporary Linguistics 48 (1): 23–54. DOI: 10.1515/psicl-2012-0003 Graf, Eva-Maria. in prep. The Discourse (s) of Executive Coaching. An Applied Linguistic Analysis. Habilitationsschrift Universität Klagenfurt. Gunnarsson, Britt-Louise, Per Linell, and Brengt Nordberg (eds). 1997. The Construction of Professional Discourse. London: Longman. Habscheid, Stefan. 2003. Sprache in der Organisation. Sprachreflexive Verfahren im Systemischen Beratungsgespräch. Berlin: Mouton de Gruyter. DOI: 10.1515/9783110201642 Hamilton, Heidi, and Syliva Chou (eds). 2014. The Routledge Handbook of Language and Health Communication. London: Routledge. Heritage, John, and Douglas Maynard (eds). 2006. Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511607172 Hutchby, Ian. 2007. The Discourse of Child Counseling. Amsterdam: John Benjamins. DOI: 10.1075/impact.21 Kallmeyer, Werner. 2001. “Beraten und Betreuen. Zur gesprächs-analytischen Untersuchung von helfenden Interaktionen.” Zeitschrift für Qualitative Bildungs-, Beratungs- und Sozialforschung 2: 227–252. Kallmeyer, Werner. 2005. “Konversationsanalytische Beschreibung.” In Sociolinguistics / Soziolinguistik, ed. by Ulrich Ammon, et al., 1212–1225. Berlin/New York: Mouton de Gruyter. Koester, Almuth. 2010. Workplace Discourse. London: Contiuum Press. Labov, Werner, and Dan Fanshel. 1977. Therapeutic Discourse. Psychotherapy as Conversation. New York: Academic Press. Levinson, Steven. 1992. “Activity Types and Language”. In Talk at Work. Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 66–100. Cambridge: Cambridge University Press. Miller, Katherine, and Jennifer Considine. 2009. “Communication in the Helping Professions.” In The Routledge Handbook of Applied Communication Research, ed. by Lawrence Frey, and Kenneth Cissna, 405–428. New York: Routledge. Mishler, Elliot. 1984. The Discourse of Medicine. Dialectics of Medical Interviews. Norwood, New Jersey: Ablex. Muntigl, Peter. 2004. Narrative Counselling: Social and Linguistic Processes of Change. Amsterdam: John Benjamins. DOI: 10.1075/dapsac.11 Neises, Mechthild, Susanne Ditz, and Thomas Spranz-Fogasy (eds). 2005. Psychosomatische Gesprächsführung in der Frauenheilkunde. Ein interdisziplinärer Ansatz zur verbalen Intervention. Stuttgart: Wissenschaftliche Verlagsgesellschaft. Nowak, Peter, and Thomas Spranz-Fogasy. 2009. “Medizinische Kommunikation – Arzt und Patient im Gespräch.” In Jahrbuch Deutsch als Fremdsprache 34/2008., ed. by Andrea Bogner, et al., 80–96. München: Iudicium.

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Pawelczyk, Joanna. 2011. Talk as Therapy: Psychotherapy in a Linguistic Perspective. Amsterdam: Walter de Gruyter. DOI: 10.1515/9781934078679 Pawelczyk, Joanna, and Eva-Maria Graf. 2011. “Living in Therapeutic Culture: Feminine Discourse as an Agent of Change”. In Living with Patriarchy – Discursive Constructions of Gendered Subjects Across Public Spheres, ed. by Danijela Majstoroviac, and Inger Lassen, 273–302. Amsterdam: John Benjamins. DOI: 10.1075/dapsac.45.15paw Peräkylä, Annsi. 1995. AIDS Counselling. Institutional interaction and clinical practice. Cambridge: Cambridge University Press. Peräkylä, Annsi, and Sanna Vehviläinen. 2003. “Conversation Analysis and the Professional Stocks of Interactional Knowledge.” Discourse & Society 14: 727–750. DOI: 10.1177/09579265030146003 Peräkylä, Annsi, Charles Antaki, Sanna Vehviläinen, and Ivan Leudar (eds). 2008. Conversation Analysis of Psychotherapy. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511490002 Pick, Ina, Yasmin Aksu, and Eva Graf. in prep. Gesprächseröffnungen in Coaching, Beratung und Supervision – eine diskursanalytische Untersuchung. Ruusuvuori, Johanna. 2005. “Comparing Homeopathic and General Practice Consultations: The Case of Problem Presentation.” Communication and Medicine 2 (2): 123–135. DOI: 10.1515/come.2005.2.2.123 Sarangi, Srikant. 2000. “Activity Types, Discourse Types and Interactional Hybridity.” In Discourse and Social Life, ed. by Srikant Sarangi, and Malcom Coulthard, 1–27. London: Longman. Sarangi, Srikant. 2004. “Editorial: Towards a Communicative Mentality in Medical and Healthcare Practice.” Communication and Medicine 1: 1–11. DOI: 10.1515/come.2004.002 Sarangi, Srikant, and Celia Roberts (eds). 1999. Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management Settings. Berlin: Mouton de Gruyter. DOI: 10.1515/9783110208375 Sator, Marlene, and Thomas Spranz-Fogasy. 2011. “Medizinische Kommunikation”. In Angewandte Linguistik. Ein Lehrbuch, ed. by Karlfried Knapp, et al., 376–393. Tübingen/Basel: A. Francke. Spranz-Fogasy, Thomas. 2010. “Verstehensdokumentation in der medizinischen Kommunikation: Fragen und Antworten im Arzt-Patient-Gespräch.” In Verstehen in professionellen Handlungsfeldern, ed. by Arnulf Deppermann, Ulrich Reitemeier, Reinhold Schmitt, and Thomas Spranz-Fogasy, 27–116. Tübingen: Gunter Narr.



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How practitioners deal with their clients’ “off-track” talk Charles Antaki

In institutional encounters where a client engages with a practitioner for advice or guidance, there is a phase in which the client may be expected to ‘tell their tale’ before the practitioner offers a response. In this chapter I shall analyse the kind of professional conversation which involves with a client being invited to describe a personal and indeed intimate problem, in order for the professional to offer their perspective (and possibly suggest a solution). The client’s problems here are matters of emotion, conflict or life-style, caused or sharpened by psychological disorder or disability – in other words, we shall be listening in to what the editors term as the ‘professional format’ of the counselling, personal- support and therapy consultation.

1. Introduction In institutional encounters where a client engages with a practitioner for advice or guidance, there is a phase in which the client may be expected to ‘tell their tale’ before the practitioner offers a response. That is the ‘interaction type’, as the editors of this volume usefully call it, that I shall concentrate on in this chapter. As the editors say, “interaction types … are … bounded (parts of) conversations with an inherent structuring of opening, core interaction and closing section, in which participants solve complex communicative tasks” (Graf, Sator and Spranz-Fogasy, this volume, p. 1). What I have in my sights is that kind of professional conversation which involves with a client being invited to describe a personal problem, in order for the professional to offer their perspective (and possibly suggest a solution). The client’s problems here are matters of emotion, conflict or life-style, caused or sharpened by psychological disorder or disability – in other words, we shall be listening in to what the editors term as the ‘professional format’ of the counselling, personal-support and therapy consultation.



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Common to all of these is the need for the practitioner to get their client to tell their troubles in some sort of narrative. The communicative task facing both parties is getting this narrative ‘ right’ – tailoring its delivery (length, detail, content) to the needs of the conversation at that point. My interest is in what happens when that tailoring goes wrong, and the narrative is stopped or diverted by the practitioner, who has judged that the client has strayed too far from the agenda – that the client has gone “off-track”. Dealing with such behaviour is a complex business, and, as we shall see, the practitioner needs to try and be firm while also being supportive. How might a client go ‘off-track’? In ritualised settings the troubles-telling stage of the proceedings is fixed and clear to both parties (for example, in a religious confessional, where the question-and answer format limits the penitent to a set time in which to recount her or his sins), and there are conventional or ritualised formats in which to deliver the trouble-description. But in more mundane interactions the boundaries are diffuse. This chapter is about what happens when the client’s troubles tale is treated by the practitioner as having spilled over into an inappropriate part of the encounter – perhaps starting too soon, going on too long, or re-emerging after it had been apparently dealt with. I will be dealing with such policing of boundaries in two very different settings in the helping professions: sessions of psychotherapy, and interactions between support-staff and people with intellectual impairments. We shall see that the manner in which very different practitioners deal with the problem of ‘off-track’ talk (indeed, whether it is a problem) shares common conversational features, and becomes itself a constituent part of what the institutional service provides. 2. Ordinary practices for discouraging talk An institution’s ways of talking is only a variant of what happens in the primordial site of interaction, which is everyday conversation (which must necessarily have predated the development of institutions). And, in everyday conversation, there is a range of practices by which a person might treat another’s talk as being off-track, or otherwise not to be encouraged. Both parties will have an eye to what Schegloff calls the progressivity of a speaker’s actions in the turn they’re currently constructing (Schegloff 1979) or in the sequence that they’re building (Schegloff 2007); and at any point one participant may decide to encourage the other in their trajectory or, conversely, steer them away from the line they are taking. Encouragement is the norm, and Example 1 shows an example of encouragement in the arrowed lines.



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Extract 1. (Rahman 1 4–6, notation greatly simplified) 01 G: And Danny didn’t get in so I didn’t get to typing 02 last night 03 → L: Didn’t [you 04 G: [No I thought well I can’t leave him for 05 two hours if I’m- if he’s crying if I’ve left 06 him for one 07 → L: Oh dear me 08 G: So er you know as I say I didn’t get to typing 09 → L: Oh you’re well tied down aren’t you

Speaker G is telling a tale about her son’s crying preventing her from typing, and speaker L’s contributions are all news receipts of an encouraging, go-ahead kind (see Heritage 1984 for the range), fitted to the newsworthiness of what is being announced, its emotional tone and showing, at line 9, an appreciation of its truth and aptness. Were the recipient of news less inclined to encourage the news-teller, they might steer them away from it gently or brusquely, forming a gradient of directness. In the case below, we are clearly towards the other end of the gradient, where D’s silence speaks volumes: Extract 2. (W:PC: I 1–3 notation greatly simplified) 01 S: Oh God we had the police round all night it was 02 hectic so I hardly got any work done 03 → ((sound of horn beeping)) 04 S: So consequently I didn’t get any work done 05 hardly. 06 → (0.6) 07 S: Anyway. 08 → (2.0) 09 D: So- do you think- can you come out for a drink 10 tonight?

S is recounting a tale about not getting work done but, unlike speaker L in Extract 2 above, speaker D is not taking their opportunities at turn-transition points (arrowed) to express encouraging news-receipts. Indeed when D does take a turn (line 9), it is after a markedly long silence, and takes the form of a topic-changing invitation to come out for a drink. Invitations project agreement, or replies of some kind, so were S to try and re-establish the topic of their undone work, they would have to pay the cost of being as disaffiliative with D’s new project as D was to theirs. The gradient of discouragement from gentle to brusque is not one-dimensional. There will be many factors in play in deciding where to place your intervention,



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and, in institutional settings, some of these will turn on the view that the practitioner has of the client, and of the client’s interests vis-à-vis those of the institution. In the body of the chapter we shall see how those concerns play out differently in psychotherapy and in support for people with intellectual impairments. 3. Interactions in adult psychotherapy, and between residential support staff and adults with intellectual impairments1 The two kinds of interaction I shall report are quite different in terms of the clients’ cognitive powers and their reasons for engaging with the practitioner. Nevertheless they share the feature of the practioner making space for the client to tell a trouble, and to then propose some assessment of it - or to manage the tale, if it strays outside what the practitioner considers to be its appropriate boundaries. In talking about psychotherapy I shall concentrate on therapies which have a programmatic approach to their interactions with clients, where the transitions between troubles-telling and other phases of the interaction are more visible and more obviously policed. In Cognitive Behaviour Therapy, for example, therapists are meant to work to a clearly set-out schedule of activities within any one therapeutic session. Figure 1 is an example of a training manual’s description of the phases that the therapist must go through.

Session structure and outline: early phase of treatment 1. 2. 3. 4. 5.

Greet patient Perform a symptom check. Set agenda. Review homework from previous session. Conduct cognitive-behavior therapy (CBT) work on issues

6.

from agenda Socialise to cognitive model. Teach basic CBT concepts

7. 8.

and methods. Develop new homework assignment. Review key points, give and elicit feedback, and close session.

Figure 1. An example of a programme for a therapeutic session (from Wright et al. 2006: 78)



1. Part of the material in this chapter is based on data and analysis in Antaki and Jahoda (2010).

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Even if the experienced CBT therapist does not stick fixedly to this brief, and even in other kinds of psychotherapy where there are less structured phases to go through, there will necessarily be times when the client’s long rehearsal of their troubles would be inconsistent with the kind of activity cast, in CBT terms, as ‘set agenda’ (which more loosely would be something like ‘agree with the client what would be done in that session’) or ‘develop new homework assignment’ (perhaps ‘make recommendations as to what the client might usefully do before the next session’). And if the client’s talk does run, on, then there is a dilemma. The therapist will have a specific therapeutic or managerial objective in mind which is to be pursued, even at the expense of seeming to be unresponsive to the client’s troubles-telling. How is the practitioner to respond? Text-books (for example, Dryden 2007) are not unaware of such issues, but they lack detail in suggesting what the practitioner is to do. As Peräkylä and Vehviläinen (2003) observe about psychotherapy practice, textbooks may sometimes offer idealised examples but such idealisations can only get across what the author believes is the general ‘feel’ of an interaction, and may be wildly different from the specifics of actual talk. Conversation Analysis will help. As Peräkylä and Vehviläinen (2003) point out, a close analysis of recorded encounters will reveal significant and unsuspected detail in how therapists actually keep the client focussed. With regard to the relationship between support-staff member and adult with an intellectual disability, the encounter is rarely so formally structured, yet there are many occasions in which staff an d client are engaged in some activity which provides for the staff member to ask the client to report on an event of concern or interest, either for purely informational reasons (the staff may need to know if there is anything wrong, or troubling the client) of out of an educational motive (the staff may need to test the client’s understanding of such things as health practices). Her the exchange takes on the basic feature of interest to us: a space3 is provided for the client to report a concern, and that report may or may not ‘fit’ the boundaries allowed it by the practitioner. Conversation Analysis (CA) is mostly applied to ordinary conversation, but has a developing interest in institutional encounters. Indeed, it has a long history of looking to see how therapy (and mental-health work in general) gets done in practice, beginning in the late 1960s with Harvey Sacks’ account of an emergency psychiatric helpline and an adolescent group therapy session (both later published in his posthumous lectures; see Sacks 1992). There has now accumulated quite a body of CA or CA-inspired work in therapy. The collection edited by Peräkylä, Antaki, Vehviläinen and Leudar (2008) shows therapists’ practices in initiating actions and in responding to what the client offers to the session. Contributors to that collection identify a number of practices that the therapist uses in

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encouraging the client to talk, and to progress the session by offering formulations, reinterpretations, assessments and repairs of the client’s words (and, by extension, the client’s view of the events he or she was recounting). In intellectual disability, Yearley and Brewer’s (1989) pioneering work effectively established that people with all but the most severe intellectual disabilities were to be taken to have interactional, if not always linguistic, competence. Since then, CA-informed research has proceeded to fill out what we know about both voices in the dialogue: the practices of people with disabilities, and the practices of those around them – who often get, or take, a larger slice of the conversational cake. But the person with intellectual disabilities does not talk in a vacuum; Marlaire and Maynard’s work (e.g. Maynard and Marlaire 1992) redirected people’s attention off the client and onto the practitioner. They studied how the tester and testee collaborated in educational assessment sessions, and identified how the practitioner could induce the testee to act less competently than they would do in ordinary conversation, or in conversation less driven by institutional objectives. Their work, and subsequent work by researchers studying interactions in more natural settings (e.g. Williams 2010; Antaki, Finlay and Walton 2009), has made CA researchers more aware of the interplay between the practitioner’s talk and that of the client, and allowed us to see their interdependence. These two traditions of applied CA form a useful backdrop to the practices we have in our sights here: how a therapist, working with people with mental health issues, or a support staff member, working with adults with intellectual disabilities, may steer the client’s talk in the direction that the institution requires. 4. Seven conversational practices to discourage the client’s trajectory and keep the session institutionally “on track” A given turn at talk opens up a space for a class of next action (thus a summons requires a response, a question requires an answer, a news report requires a news receipt, and so on – for a recent magisterial account of conversational sequences, see Schegloff 2007). When a client is making her or his report, that usually projects some sort of appreciation (a new receipt or an assessment). That keeps the interaction going on its trajectory, and the client is enabled to carry on. What we shall see, however, is that the practitioner can meet the client’s words with a gradient of responses that, on the contrary, redirect, or try to redirect, the client’s progress. The practitioner’s redirections range from giving only minimal receipts of what the client has said, even when this would otherwise have warranted



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expansion, all the way to explicit active topic shift which takes a more directive role. Such deviation is marked, and makes the talk go off on an alternative trajectory from the one that the previous speaker had indicated. To prefigure what we shall see, the gradient is composed of the following practices, in ascending order of explicit direction (building on five practices identified in Antaki and Jahoda 2010): – – – – – – –

minimal receipt of newsworthy announcements non-request for clarification of confused narrative repeat of C’s turn, or part of it formulation which closes the topic orientation to the need to keep on track non-engagement with client’s talk explicit rejection of client’s track

The practices are not exclusive, and we shall see how a practitioner may use a combination of practices, either across subsequent turns at talk or within one turn. (1)

The practitioner offers only a minimal receipt of announcements

When a person reports some event as an announcement, it can be met by a range of more or less encouraging receipts (Heritage 1984). Therapy sessions, certainly, are environments where clients are encouraged to announce their concerns, and they require at least acknowledgement by therapist (active listening is a phrase often used, in therapy texts, to describe appreciating the client’s situation). Equally, a person with intellectual disabilities may well be asked to report on events in their day to day lives as part of what is called person-centred care. Again, such reports can be met more or less encouragingly. In all cases, the practitioner may judge that after a certain moment, the time is not right to encourage the client to elaborate on a given report. In the case of the CBT therapist for example, it would be unwelcome for the client to elaborate on their troubles in the in an agenda-setting phase, or in a homework review phase. In Extract 3 below, the therapist is making a list of things to cover in the session, and asks the client for clarification of how to word an item on hearing voices. In this, as in all the extracts used, any names that appear are pseudonyms, and any other identifying material has been removed or altered. “C” is the client, and “T” the therapist.



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Extract 3. CBTM: SH/JR Session 1, min 162 01 T: .hh okay, (.) so far we’ve got. (.3) no bedtime 02 routine, sleep, drinking a lot of water, worried 03 about epilepsy. (.) .hh 05 (1.3) 06 T: or [no:t 07 C: [erm::: 08 T: or is it shouting at the voices that’s the problem. 09 (1.6) 10 C: (w- er- I- er-)=sometimes ah- I (.3) I scream very 11 loudly 12 (.6) 13 C: ts a bit of a problem (.) >bcs=sometimes,< I 14 scream s’loudly ahm=ma gla- ma ears hurt. 15 → T: so=sh’ll we (.) put problems= [screaming loud at 16 C: [scree17 T: the voices. 18 (.3) 19 C: yeah. 20 T: good one.

In the extract above, the client’s announcement sometimes I scream very loudly receives no acknowledgement from the therapist. The client then upgrades the report to sometimes I scream so loudly my ears hurt. Such ‘news announcements’ (Heritage 1984) strongly project explicit new-receipt by the listener (for example: really? do they? oh? among the more encouraging ones; see Heritage 1984). But the therapist gives no assessment or receipt whatever, instead meeting the announcement with a proposal of how to record the client’s experience (the arrowed line 15), in line with the current business of the session, which is setting the day’s agenda. (2)

The practitioner does not request clarification, even for unclear narrative

In both sets of interactions, clients’ accounts may be difficult to follow, for various reasons; in some cases it is due to cognitive difficulties in formulating language, and in other cases it might be because the client is overwhelmed by their feelings, and in still other cases it may simply be due to the complexity of the events they



2. I am grateful to Ivan Leudar for access to data marked “CBTM”.

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are reporting. In everyday talk, the listener has a range of practices open to them to prompt the speaker to clarify what he or she is saying. Such prompts encourage the speaker to go on, and to elaborate. What is noticeable in the data here is that the practitioners will, even when there is a manifest obscurity in what their client is saying, forgo such prompts for clarification. The upshot is that the client’s tale runs into the sand. Consider what happens below, in Extract 4. The therapist asks the client to explain how he felt (lines 1–2) about an episode which had been established a little before this extract begins. As you will see, the client starts off with an answer to that question, but quickly veers off into a narrative report about the events of a certain day. In the extract, blank space between brackets identifies talk which is impossible to transcribe, and words in brackets represent a guess at what the client possibly said. Extract 4. AJ4 min 15.00 “Buzzer” 01 T: So how did it make you feel at the time 02 when that happened? 03 C: >I felt a bit, I was in a, I was a bit, ( )< 04 that day. 05 T: Uh huh 06 C: I think she picked the wrong person. 07 → T: Mm 08 C: Cause the lassie’s, the lassie’s (too noisy to go 09 wi’). 10 → T: Mm hmm 11 C: Her just keeping the, keeping the buzzer, pressing 12 the buzzers? 13 → T: Mm hmm 14 C: ( ) (a’ the time). But she said it was my 15 close, to Helen, keep back from my door. Stop 16 pressing my buzzer. 17 → T: Mm 18 C: But I’m not daeing it. But they kept, the close 19 that day.

Possibly the client means his report on the events at his home to shed light on his feelings, but what he is saying is very unclear (possibly it involves troublesome neighbours). The doubt that it might not to be about ‘feelings’ at all seems to induce the therapist to forego any directive prompt that would encourage elaboration. At the arrowed lines, the therapist receives this narrative with the most minimal “continuers” (Schegloff 1982) which signal only that he is attentive, but forgo



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clarification of the story, on the basis (we presume) that the story is a distraction from the therapeutic goal of the moment, namely to get the client to articulate his emotional reaction rather than the details of the physical events. (3)

The practitioner echoes part of client’s turn as a prelude to topic shift

Topics in conversation are often shifted ‘step-wise’ (Jefferson 1984) – that is, not by an abrupt change of gear (though that can happen) but by some prefatory work that projects the closure of one topic and the potential to open another. One way of doing the prefatory work that seems apt for the institutions of therapy and supporting people with intellectual impairments is to repeat back to the speaker something they have said, as a form of confirmation or understanding check. This generates the expectation that the client will confirm their ‘own words’, and allow the practioner a more open field in which to project her or his own turn. In the extract below, from a psychotherapy session, the therapist is in the process of getting the client to list episodes of distress. However, the client takes the opportunity to go beyond mere listing, and begins a narrative, seemingly involving an episode of domestic troubles. Note how the practitioner summarises what the client says as a preface to moving on by ‘just thinking about’ a related topic. Extract 5. AJ4 min 9.00 “moonlighting” 01 C: Too much in m’mind, it’s- today I came 02 happy but there’s still inside (yer) hurt. 03 T: Uh huh. Uh huh 04 C: The hurt hat’s er-, I mean, (when y’r sayin’) 05 something. Because of the carry on with the missus. 06 I was still watching what she, what she done. 07 T: Right 08 C: They were watching us up in the house, got us 09 up in the house. Moonlighting the furniture. 10 See when the kids ( ) back home, (ma home). 11 → T: Took the kids (out of) the house, back [(t’yer own), 12 C: [Aye. Yeah. 13 T: OK. What about, em, hhh j- just thinking about this, 14 you know, it’s great, because the last time, you know, 15 you’ve a really good memory of what we did the last 16 time.


The client is relating a story, which may be over-elaborate for the needs of this stage of the session. The therapist’s summary echo and confirmation at line 11


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moves the talk away from the vivid detail of the story, and the demands of contiguity (Sacks 1987), and prefaces a move the conversation back onto the business of the session. (4)

The practitioner offers a ‘formulation’ of client’s talk which closes the topic

In the preceding section, we saw how a therapist could ‘echo’ and clarify the client’s actual words. That is a specific variant of a more general practice of proposing to a speaker what is ostensibly a mere summary or natural consequence of what they’ve just said – what Heritage and Watson call ‘gist’ and ‘upshot’ formulations. What gives a formulation extra spin, however, which can be used to bring the talk back ‘on-track’, is that it deletes a certain part of what the client said, and, in selecting another part, transforms it to some degree (Heritage and Watson 1979). In this example, the therapist is taking down the client’s history in an early session. The objective is to make a record of his episodes of voice-hearing, and specifically their extent (not their content). Extract 6. CBTM AG/HD session 1 “Nasty voice” 01 C: b’t it j’st seem to be a nasty voi-I might feel a bit 02 (.)bit better, when soon’s=I (.6) er y’t- (1.0) 03 >wunnit,wunnit< wite (.) wite- why’it says summi’ 04 like er (.3) (.) er (bitch) or (tick=or) summin’ like 05 ‘at >n’ye-< (.4) .h (.) but ee- ee- it does (.) (or 06 dog or whatever) (.) it’s very er- it’s 07 menacing, you know, 08 T: m:: 09 C: doesn’t seem to er go away, (.5) (‘n)’it’s very nasty. 10 → T: so it’s not long [sentences then is it. (.) it’s [not 11 C: [(yeh snog-) [no 12 → T: er (.3) it’s saying the odd [word and repeatin’ it]

The client is understandably concerned to get across the subjective emotional tone of the voices he hears, but the therapist has a different objective: to determine the (as it were) objective extent or depth of the hallucination – how long it lasts, how articulate it is, and so on. Hence, rather than orient to the troubling nature of the voice, (it is nasty and very menacing), the therapist at line 10 formulates the issue as being (merely) one of sentence length: it’s not long sentences then, it’s not er it’s saying the odd word and repeating it. This deletes the nastiness of the voice in favour of the diagnostic issue of articulacy. The client at first plays along (yeh



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repeatin whole sentences) but then he adds more detail (not shown), again of a troubling sort: hittin someone or whatever or losing me rag (an idiom for ‘losing my temper’, in British English). Again the therapist formulates the trouble away: yeah so you’ve been doing a lot of writing down. This allows her to bring the talk back to the current agenda. In the example below, from a different pair of client and therapist, the therapist has the same recourse to a minimising, topic-closing formulation, again formulating a neutral gloss on a highly-charged report: Extract 7. CBTM SH/JR 07/07/98 min 47 “Rubbing” 01 C: I saw the sexual act before really, bc’z- (1.1) 02 once, this bloke, (.3) this bloke came in th-=might 03 have been (h’)boyfriend, (.) .h and he just put a 04 hand between her legs and started rubbing, y’know, 05 (.5) an (I=ws) terribly embarrassed, >I s’d< 06 Gra:ce, y’know, (.5) an er (.5) she just 07 looked at me an looked away y’know, an em (.7) 08 as if it didn’t matter y’know, (.5) >but I thought 09 that< w’z horrible, really. 10 (.5) 11 → T: some very strange goings-on there really, weren’t 12 there. 13 (.8) 14 C: ye:ah.

At the point in the session where this exchange takes place, the therapist is trying to get the client to agree to do ‘homework’ – to practice certain behavioural and cognitive procedures which will combat negative memories. The client nevertheless dwells on a narration of the details of a distressing childhood experience; such troubled announcements provide normally for encouraging news receipts. As we saw in the example of the voice-hearer above, the therapist not only withholds such encouragements but goes further, and offers a neutral formulation of the client’s trouble: some very strange goings-on there really, weren’t there (lines 11–12). The formulation not only deletes the vivid detail of the tale, but – especially with the agreement-projecting tag question, solicits affirmation from the client. Thus an ostensibly simple summary of ‘her own words’ has been used to bring the topic to a less distressing and more neutral close and allow the therapist to proceed with the task of setting the homework.



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The practitioner explicitly orients to the business at hand

We are going up the gradient of what the practitioner can do to pull the client’s talk back on track. As we move towards more directive tactics, we see that the practitioner can explicitly orient to either the management of the interview, which we shall see later, or, in the first case we see below, to reintroduce a question that has still not been dealt with satisfactorily. In Extract 8 immediately below a psychotherapist is in the process of getting the client to say how he felt at certain points during the previous week. The client has nominated an occasion on which he felt angry with his ex-wife, but at line 7 he switches time-frame to the present, and report his current feelings. Note how the therapist receives this off-track talk. Extract 8. AJ4 min 11.30: “Hurts” 01 C: And then she phones back, comes later and says, 02 I got your message,= I say, I phoned you three 03 times( ). How’ve you no phoned back ( ) 04 T: Right 05 C: And (I say ok then). 06 (1.0) 07 C: It still hurts me no seein’ Craig. 08 T: Mm hmm. OK. Ab- absolute-=An- and how did you, 09 → you know, when you spoke to her, how were you when 10 → you spoke to her?

After the client’s disclosure of his current feelings, it would have been open to the therapist to enquire further into the client’s distress at not seeing his son. Instead, what we see is the therapist respond with a minimal receipt (as in examples seen earlier) and explicitly reissue the question that is pending – how the client actually felt during that episode: how were you when you spoke to her? A further, and still more directive practice is open to a practitioner – an orientation to the management of the talk. By its very nature, the structure of an interaction between client and practitioner is one where there is a more-or-less fixed set of objectives to be got through; and because of the asymmetry in who has rights to move the talk along, it falls to the practitioner to monitor this progress. They can invoke it explicitly, as in this case, which occurs in the early part of the session where a therapist is generating an agenda for the meeting. We join after the client has been talking for some time about her difficulties in getting to sleep:



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Extract 9. CBTM: SH and JR Session 1 min 6: “Sleeping” 01 C: but I suppose I should get into bed 02 at eleven o’clock, but if I get into bed at 03 eleven o’clock- (.5) I feel like my voice is 04 echoing, you know like when you’re talking an’ 05 (.3) y’feel like your voice is outside of your 06 head, (.7) it’s strange. 07 (.6) 08 C: ern 09 (.5) 10 C: but erm (1.2) .pt if- (.3) () 11 ( [ ) 12 T: [.hh13 (.3) 14 → T: I wonder if you’d mind if I kindov- (.3) just 15 → stopped you there for a moment, (.) cos we’ve 16 → [got quite a lot of things=we were setting an 17 C: [(-) 18 → T: agenda, (.) .h just to help us structure the 19 → session a little bit

The client has been talking for some time about her difficulties in getting to sleep and at line 10 issues what might be construed as an invitation to the therapist to help her formulate her words and describe her feelings more accurately. But this would be to prolong a troubles-telling in a part of the session devoted to agenda-setting, and the therapist takes the opportunity instead to issue a politely marked request that the client stop there. We are clearly moving up the gradient of direction. (6) Non-engagement with the client’s talk In the data from interaction s between support staff and adults with intellectual disabilities, but not in the therapy sessions, it was quite common for the practitioner to ‘tune out’ clients’ talk that was considered to be irrelevant or distracting. Even if the client explicitly solicited a response from the staff member (in the form of a question, for example), the staff, on many occasions, did not abide by the expectation to provide the response, and instead pursued a different trajectory (either involving that client, or involving others, or on some other business). Here is a typical example. Staff members Kath and Oonagh are establishing where each of the residents wants to go on holiday. While Oonagh is recording another resident’s choice, Alec addresses talk to her, but she does not respond (line 3).



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Extract 10. CHW VD17 4:19. Holidays / who’s that? 01 ((Oonagh is writing)) 02 Alec (to Oonagh) (but y’ can’t see cars, see cars.) 03 Oona [((continues writing without looking up))] 04 [ (2.0) ] 05 Alec (to fellow resident Oliver) who’s that then 06 (pointing at something in a brochure) 07 Oliver ((gets up and adjusts his clothing, without 08 orienting to Alec)) 09 Kath (to another resident, Dominic) are you happy to 10 with Oliver, Dominic? 11 ((Kath continues to talk with Dom for c. 11 seconds)) 12 Dom nods 13 Kath good, well done, thumbs up, 14 Alec (to Kath) who’s that one (pointing at something in 15 a brochure) 16 Kath (not looking at Alec, but possibly at the brochure) 17 oh:kay: 18 Oona ( ) read the last 19 Kath well j’s read the last one 20 Oona of the last meetin’ 21 Kath oh:kay: (.5) allright ((looks up addressing the 22 table as awhole)) we’ll jus- read what you wanted 23 to do last time. 24 Alec ((while Kath continues, he leans back in his chair 25 and looks away))

After failure to get a staff member to respond to his observation (which is not well formatted), Alec poses a question to a fellow resident, but again is unsuccessful. Then he waits until Kath has finished her questioning of Dominic (signalled by her assessing his responses as ‘good well done, thumbs up, line 13), and asks her a direct question (line 14–15). Kath’s utterance at this point (lines 16–17) is ambiguous as to its orientation. It may be an acknowledgement of Alec’s question (though it is not a reply to it), but it may be a preface for a general announcement of next topic. After a prompt from Oonagh, Kat’s full turn at lines 21–23 reveals it, at least retrospectively, to have been this general announcement. So in this brief episode, Alec’s efforts to get the talk onto his own track have been ignored by the staff, who pursue the institutional objective in hand.



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Explicit rejection of the client’s track

The most outright discouragement of the client’s talk is to explicitly reject it as a topic for joint attention. This does not happen in any of the therapy data I have seen, but, though rare, does happen in interactions between support staff and adults with intellectual impairment nt. Here is an example, from an occasion in which staff and residents are having lunch. Dominic (who has some language, but tends to use gestures and idiosyncratic signs) is responding to a joke by Alec, another resident, who wants to “put him in a skip” for bringing too many pepper pots to the table. Staff member Peter is trying to understand what Dominic is gesturing and saying. Extract 11. BW-VD11 09.40 “Dunno” 01 Dominic (gestures making circles in fornt of his eyes, 02 then “writing” in the air) 03 Peter Which one’s that one. Talk, I can’t under[stand. 04 Alec [In a skip. 05 Dominic (gestures to lips, and eyes as before) 06 Peter Lady, with glasses, ( ) 07 Dominic (gestures shaking finger “no”, points upwards) ( ) 08 Alec In a skip? 09 → Peter (eyes down to plate, eating) Dunno which one you’re 10 on about, mate.

The resident’s attempt to tell his tale, in his own way, is discouraged by the staff member: at first in an exhortation to speak (line 3), even though this resident is not a confident language user; and finally an explicit refusal to engage with his narrative project (lines 9–10). As I say, I have no examples of this in the therapy data, which suggests that such disengagement is not appropriate to the therapeutic relationship; but it does happen in care settings, where the institutional imperatives are very different. 5. Concluding comments The focus of the chapter has been on the interaction type of the problem-based interview, and the professional format of counselling or support-based interaction between clients with cognitive difficulties and their practitioners. The specific question we asked was how the practitioners dealt with the particular communicative task of the troubles narrative – especially, the narrative that went “offtrack”. We have seen how practitioners have a spectrum of practices to deal with



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their clients’ talking such cases; that is to say, when it delays what the practitioner considers to be other, over-riding objectives for the conversation to fulfil at that point. We saw examples from cognitive behaviour therapists, and from support staff working with adults with intellectual disabilities. Least discouragingly, the practitioner could merely forgo offering receipt of newsworthy announcements, and at the most discouraging, they could issue an explicit rejection of the client’s narrative. In between, in ascending order of directness, they could: let pass confused narrative; use a repeat of part of the client’s turn as a pivot towards a different direction; formulate the client’s talk in a way that closes the client’s topic; and making an overt orientation to the need to keep the conversation ‘on track’. Sampling the interactions of two very different kinds of mental-health practitioner allowed us to see more of a spectrum than had we concentrated only on one – it was certainly the case that, although usage overlapped, the more directive end of the spectrum was only used by staff members in the care institution, and not by psychotherapists. Indeed, the kind of psychotherapy we sampled here (cognitive behaviour therapy) itself may also mandate the use of certain kinds of practice, and were we to investigate other kinds (psychodynamic psychoanalysis, for example, or Rogerian therapy), still other kinds of practices might come to light. The particular stations on the spectrum that we identify here, then, are only a provisional list. But it seems reasonable to say that these practices do form a collection, an that they provide the practitioner with a way of dealing with a recurrent institutional problem, to be solved by means consistent with their institutional imperatives.

Transcription symbols (adapted from the Jefferson system standard in Conversation Analysis) (.)

(.3), (2.6) word [word] [word] .hh, hh wor-

wo:rd (words) (

)



word, WORD °word°

Just noticeable pause. Examples of timed pauses, in seconds. Square brackets aligned across adjacent lines denote the start and end of overlapping talk. In-breath (note the preceding full stop) and out-breath respectively. A dash shows a sharp cut-off. Colons show that the speaker has stretched the preceding sound. A guess at what might have been said. Talk too unclear to merit even a guess. Underlined sounds are louder, capitals louder still. Material between “degree signs” is quiet.

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>word word< Inwards arrows show faster speech, outward slower. wo(h)rd (h) shows that the word has “laughter” bubbling within it. ((gruff voice)) →

Attempt at representing something hard, or impossible, to write phonetically. Analyst’s signal of a significant line.

References Antaki, Charles, and Andrew Jahoda. 2010. “Psychotherapists’ Practices in Keeping a Session “On-track” in the Face of Clients’ “Off-track” Talk.” Communication & Medicine 7: 11–21. DOI: 10.1558/cam.v7i1.11 Antaki, Charles, W.M.L. Finlay, and Chris Walton. 2009. “Choice for People with an Intellectual Impairment in Official Discourse and in Practice.” Journal of Policy and Practice in Intellectual Disabilities 6 (4): 260–266. DOI: 10.1111/j.1741-1130.2009.00230.x Dryden, Windy (ed.). 2007. Dryden’s Handbook of Individual Therapy. London: Sage. Heritage, John. 1984. “A Change of State Token and Aspects of Its Sequential Organisation.” In Structures of Social Action, ed. by John. M. Atkinson, and John Heritage, 299–345. Cambridge: CUP and Paris: Editions de la Maison des Sciences de l’Homme. Heritage, John, and D.R. Watson. 1979. “Formulations as Conversational Objects.” In Everyday Language: Studies in Ethnomethodology, ed. by George Psathas, 123–162. New York: Irvington. Jefferson, Gail. 1984. “On Stepwise Transition from Talk about a Trouble to Inappropriately Next-positioned Matters.” In Structures of Social Action: Studies of Conversation Analysis, ed. by John M. Atkinson, and John Heritage, 191–222. Cambridge, UK: Cambridge University Press. Maynard, D.W., and C.L. Marlaire. 1992. “Good Reasons for Bad Testing Performance: The Interactional Substrate of Educational Exams.” Qualitative Sociology 15: 177–202. Peräkylä, Annsi, Charles Antaki, Sanna Vehviläinen, and Ivan Leudar (eds). 2008. Conversation Analysis and Psychotherapy. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511490002 Peräkylä, Annsi, and Sanna Vehviläinen. 2003. “Conversation Analysis and the Professional Stocks of Interactional Knowledge.” Discourse & Society 14 (6): 727–750. DOI: 10.1177/09579265030146003 Sacks, Harvey. 1987. “On the Preferences for Contiguity and Agreement in Sequences in Conversation.” In Talk and Social Organisation, ed. by Graham Button, and John R. Lee, 54–69. Clevedon: Multilingual Matters. Sacks, Harvey. 1992. Lectures on Conversation. Oxford: Basil Blackwell. Schegloff, Emanuel A. 1979. “The Relevance of Repair to Syntax-for-Conversation.” In Syntax and Semantics, Volume 12: Discourse and Syntax, ed. by Talmy Givon, 261–286. New York: Academic Press. Schegloff, Emanuel A. 1982. “Discourse as an Interactional Achievement: Some Use of ’uh huh’ and Other Things that Come Between Sentences.” In Analyzing Discourse: Text and Talk (Georgetown University Round Table on Language and Linguistics), ed. by Deborah Tannen, 71–93. Washington, DC: Georgetown University Press.



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Schegloff, Emanuel A. 2007. Sequence Organisation in Interaction. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511791208 Williams, Val. 2010. Disability and Discourse: Analysing Inclusive Conversation with People with Intellectual Disabilities. Chichester: Wiley-Blackwell. Wright, Jesse H., Monica Ramirez Basco, and Michael E. Thase. 2006. Learning Cognitive-behavior Therapy: An Illustrated Guide. Arlington: American Psychiatric Publishing. Yearley, S., and J. Brewer. 1989. “Stigma and conversational competence: a conversation analytic study of the mentally handicapped”. Human Studies 12: 97–115.



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Empathic practices in client-centred psychotherapies Displaying understanding and affiliation with clients Peter Muntigl, Naomi Knight and Ashley Watkins

We explore how client-centred empathy is practiced within a specific interaction type: troubles telling sequences. Building on the work of Carl Rogers, who viewed empathy as a form of understanding that privileges the client’s point of view, empathy is examined as an interactional achievement in which clients create empathic opportunities by displaying their affectual stance, followed by therapists taking up these opportunities through affiliative displays. We found that empathic practices could be realized through a variety of verbal (naming other’s feelings, formulations, co-completions) and non-verbal resources (nodding, smiling). Further, we found that continuers played an important role in helping clients to develop their troubles stance in more detail, which, in turn, invited more explicit empathic displays from therapists.

1. Introduction According to Carl Rogers (1951), practicing empathy involves the ability to communicate one’s understanding of another’s experience and to refrain from appearing as an expert who interprets or assesses another’s experience. What is important is to preserve the client’s own personal frame of reference: “to sense the client’s private world as if it were your own, but without ever losing the ‘as if ’ quality – this is empathy” (Rogers 1957: 99). Empathy forms a core communicative task in client or person-centred approaches to psychotherapy and counselling (Greenberg, Rice, and Elliot 1993; Rennie 1998; Rogers 1951). The positive effects of empathy are reported to be extensive and far-reaching: Communicating empathy is considered to be especially important in fostering positive social bonds, improving the quality of care and helping to achieve good treatment outcomes (Greenberg et al. 1993; Suchman et al. 1997).



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Peter Muntigl, Naomi Knight and Ashley Watkins

Research in conversation analysis (CA) has begun to shed light on how empathy is practiced by professionals in helping contexts of doctor-patient (Ruusuvuori 2005, 2007), caller help line (Pudlinski 2005) and counsellor-child (Hutchby 2005) interactions. Very little work, however, has so far illuminated the therapist’s empathic practices used in psychotherapy. For this paper, we draw on the research methods of CA to explore how therapists with a client-centred orientation put empathy into practice in face-to-face therapy contexts involving clients’ problems talk. Our analyses are taken from video-taped sessions of individual therapy involving depressed clients.1 Clients were offered either of two forms of treatment that adhered to a person-centred, relational style of practice advocated by Carl Rogers: Client-centred Therapy (Rogers 1951) or Process Experiential Therapy (Greenberg et al. 1993). In order to examine how empathy is communicated to clients by therapists, we focus on a specific interaction type: clients’ troubles telling sequences. We show (1) how empathic displays to a client’s troubles telling are accomplished both verbally (e.g., formulations, co-completions) and non-verbally (e.g., smiling, nodding); and (2) how verbal and non-verbal resources work synergistically in storytelling contexts to create ongoing, local points of empathic contact between the therapist and client. By examining the interactional practices through which therapists do empathy, we shed more light on the process in which understanding someone’s personal situation is an interactional achievement and on how therapists work within a client-centred professional format to foster affiliation with clients. 2. Concepts of empathy in the helping professions: A brief overview A short history of the term empathy and how it came to be conceptualized – especially in psychotherapy – is given in Barrett-Lennard (1981). He argued that the modern day usage of empathy stems from the German word Einfühlung. Although the term first came to be related to “feeling into” a work of art or object of nature, it later came to be associated with knowing about others and their experiences or, put differently, being able to adopt the point of view of some other. It was Carl Rogers, however, who refined this concept by underscoring the difference between understanding someone’s experience in an empathic sense and actually being able to identify with (i.e., actually feel) other’s experience. As Rogers (1951: 29) argues:



1. We thank Lynne Angus and Les Greenberg for allowing us access to these data.

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…experiencing with the client, the living of his attitudes, is not in terms of emotional identification on the counsellor’s part, but rather an empathic identification, where the counsellor is perceiving the hates and hopes and fears of the client through immersion in an empathic process, but without himself, as counsellor, experiencing those hates and hopes and fears. [italics ours]

Roger’s view of empathy and how it is to be used in counselling and therapy relates specifically to his client-centred approach; that is, the therapist’s responses should not be directive by interpreting or assessing the client’s experience. Instead, responses should give priority to the client’s frame of reference and thus allow the client to maintain ownership of his/her own experience. Various developments, discussed in McLeod (1999), have been proposed over the years regarding the conceptualization of empathy. In promoting a social constructionist view of empathy, McLeod (1999) argues that the relational aspect of empathy has not been given enough attention. Drawing from the work of Barrett- Lennard (1981), McLeod offers a process view in which therapist and client move through a series of stages in order to co-create an empathic event. From this perspective, empathic understanding cannot be reduced to a therapist technique, but instead encompasses a sequence of actions that surround the therapist’s communication of empathy – such as the experience expressed by the client, but also the client’s response to the therapist’s display of empathy. McLeod’s emphasis on co-construction also has implications for the way in which the therapist’s role can or should be viewed: as someone who simply reflects back an understanding of the client’s experience, thereby taking on a more passive role, or as someone who more actively works to transform the client’s experience. As McLeod (1999: 390) argues: The idea that the counsellor or psychotherapist can ‘enter the client’s frame of reference’ or ‘walk in the world of the other’ implies that this frame of reference or ‘world’ is a fixed entity that can be observed in the same way that a picture or other art object can be observed. In this sense, the concept of empathy is difficult to reconcile with a social constructionist perspective in which experience and reality are intrinsically co-constructed, emerging from a meeting or conversation between members of a culture.

McLeod (1999) also draws our attention to the importance of client narratives in enabling the collaborative achievement of empathic understandings during therapeutic interactions. This is because narratives play such an important role in giving order, meaning and value to our experiences (Bruner 1986; Labov 1972; Labov and Waletzky 1967). In this way, client stories can be seen as primordial sites of potential empathic engagement between the therapist and client. By



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telling stories, clients provide therapists access to their feelings and judgements (or affectual stance, Stivers 2008) about certain important life experiences; that is, through this form of recipient design (Sacks, Schegloff, and Jefferson 1974) in which clients tailor their stories to fit the therapist’s role (and the institutional task at hand), it becomes possible for therapists to display their understanding of the unique perspective that the clients are putting forth. 3. Empathy in interaction Our starting point in addressing the issue of how a Rogerian, client-centred angle on empathy is realized in psychotherapy talk is taken from research that has explored empathic displays in everyday and institutional contexts (Jefferson 1988; Pudlinski 2005; Ruusuvuori 2005, 2007; Stivers 2008; Suchman et al. 1997). From this work, three kinds of discursive issues crystallize out as being especially important for understanding how empathy is collaboratively accomplished in sequence. First, a client’s telling of a trouble creates what Suchman et al. (1997) have referred to as empathic opportunities. It will be shown how these opportunities are closely tied to how a client is conveying a certain stance (Biber and Finegan 1989; Stivers 2008) that involves expressions of attitude, affect or judgements targeting people or events. Second, empathic opportunities invite professionals to produce an empathic response. However, although researchers have identified a range of empathic practices in the helping professions, not all of these practices are client-centred and some may not be appropriate for doing client-centred empathy in psychotherapy. For instance, emotive reactions (e.g., “Oh:: sh:i:t.”) commonly found in peer help lines (Pudlinski 2005) may signal to clients that the therapist is sharing too strongly in their negatively-oriented stance and could be read as sympathy rather than empathy, while second stories found in medical interviews (Ruusuovori 2005), although potentially affiliative, may remove the focus of the conversation away from the client and onto the therapist. Such responses, therefore, have the potential to move the conversational track away from the therapeutic activity at hand, creating a markedly different kind of interaction that is less focused on eliciting the client’s feelings and views. Third, the ‘turn design’ of the professional’s response is important, as even rather minor deviations in, say, affiliative strength may convey something other than empathy to the client. Whereas communicating a degree of affiliation with the client’s telling that is appropriate to the context of the telling will position the professional as an empathic ‘troubles recipient’ (Jefferson 1988; see Section 3.1), any departures from this may result in the client inferring that the professional



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is not orienting to the client’s talk as genuine ‘trouble’ or that the professional is sharing emotionally in the client’s difficulties. Thus, the design and ‘strength’ of the professional’s response will be a critical factor in determining whether the professional is doing empathy or something else. 3.1

Creating empathic opportunities: Troubles telling2

One common thread that runs across the different helping professions is the general scenario in which clients seek out professionals for assistance and, in doing so, offer a “report of a problematic experience” (Ruusuvuori 2005: 204–205). Following Jefferson (1988), these contexts realize what is known as “troubles talk”. Client troubles may take on myriad forms. In medicine, for example, troubles often relate to a patient’s physical/biological ailments, whereas in couples counselling, relationship troubles tend to get put on the agenda. Jefferson’s (1988) work has shown that troubles telling is an activity that is germane to everyday, not just institutional, contexts. Compare examples (1) and (2), taken from Jefferson (1988: 425): (1) [NB:IV:4:1]:3 → E: → E: L: L:

Bud left me last night. (1.0) He [got- ma:d and went off uhh huh huh! [( )(0.4) Did he really?

(2) [NB:II:5:2ffR]: → E: God he wanted to pull a tooth [and make me a new go:ld uh L: [a h h h h ! → E: .hhhhhh (.) bridge for (.) EI:GHT hundred dollars. L: Oh:: sh:i:t.

2. Although our focus for this paper is on troubles tellings, we do not wish to imply that only these contexts are appropriate for examining empathy. Displaying access to and understanding of the client’s viewpoint would also be relevant for tellings that convey ‘positive’ news or that contain various affectual meanings involving hope, fear, surprise, etc. that are not necessarily associated with a ‘trouble’.



3. See Jefferson (2004) for transcription conventions.

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In each of these examples, the trouble, as expressed by E, is realized as a (negative) assessment of a specific event that directly involves the teller: Bud abruptly leaving in a huff in (1) and the outrageous costs of dental work in (2). Jefferson further argues that recipients to troubles tellings commonly, but not always, respond with empathy. Thus, although an empathic response is a relevant next action in troubles telling contexts, other next actions are also possible – the topic of empathic responses will be explicitly dealt with in Section 3.2. According to Suchman et al. (1997), a patient’s telling of their troubles created what they term empathic opportunities for the physician, especially if the patient expressed emotions when discussing their symptoms. Thus, the expression of attitudes or emotions is essential for doing empathic work, because they are affiliate-able; that is, they allow helping professionals to (1) ‘enter the client’s frame of reference’ or ‘walk in the world of the other’ (McLeod 1999) and (2) display their understanding, appreciation and attitude concerning the expressed trouble (Stivers 2008). In linguistic and social interaction research, the expression of attitudes or affect in interaction falls under the domain of what is termed stance (Biber and Finegan 1989; Stivers 2008). In the sub-sections to follow, we describe how tellers/clients construct a stance and thus create empathic opportunities for their recipients. 3.1.1 Teller’s stance Biber and Finegan (1989: 93) define stance as “the lexical and grammatical expression of attitudes, feelings, judgements, or commitment concerning the propositional content of a message.” Examples demonstrating how lexicogrammatical resources work to convey stance are drawn from Suchman et al. (1997) in (3) and from our own psychotherapy data in (4): (3) Physician-patient interaction (from Suchman et al. 1997: 679): Physician: How do you feel about the possibility of cancer – about the possibility of it coming back? → Patient: Well, it bothers me sometimes but I don’t dwell → on it. But I’m not as cheerful about it as I was → when I first had it. I just had very good feelings → that everything was going to be all right, you → know. But now I dread another operation.



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(4) Bonnie Case 305.02(5) (from Muntigl, Knight, and Watkins 2012: 13):4 01 Bonn: we she couldn’t see why they couldn’t stay for → 02 dinner. well I mean (.) why make it difficult fer → 03 people eh? 04 Ther: [ mm hm:. ] → 05 Bonn: [e mean, don’t chu] think that’s kina mean, hhh 06 huhhuh hehheh

Whereas in (3) the patient expresses mixed emotions in conjunction with the possibility of cancer recurrence (i.e., “bothers”, “not as cheerful”, “very good feelings”, “all right”) and with having to undergo another operation (“dread”), the client in (4) negatively appraises her daughter’s mother-in-law, who pressured her daughter to stay for dinner despite her plans with friends (i.e., “making it difficult”, “that’s kina mean”). Thus, in both cases the teller’s stance is realized through various lexicogrammatical expressions (e.g., verbs, nouns and adjectives) that convey affect and judgement. A teller’s stance, however, may also be expressed through resources that are not lexicogrammatical. Recall that in example (2), E’s stance involved both an assessment and a judgement in which the cost of a dental bridge was assessed as being much too high and, because of the high cost, an implicit negative judgement was realized in which the dentist might be seen as trying to swindle E. Although certain lexical items such as the expletive “God” did contribute to E’s stance, there are other resources, non-lexicogrammatical ones, that are clearly doing stance work. Stivers (2008: 38), for example, has argued that prosody and story prefaces also constitute key stance constructing resources. We can see E putting prosody to use in this way by placing forceful emphasis on “EI:GHT”, thus creating the implication that the dentist’s proposal is too high and is to be assessed negatively. By itself, however, “eight hundred dollars” does not directly convey a negative assessment. Rather, it is by packaging this phrase within a certain prosodic form that gives readers access to the view that the cost is excessive. 3.1.2 Potential empathic opportunities A teller’s stance is not always directly or explicitly expressed. This may be seen in example (1). Here, the troubles telling (“Bud left me last night.”) is uttered more


4. Our transcripts follow the CA notation given in Jefferson (2004), with the exception of conventions for intonation contours and transcriber’s ‘descriptions’. Our modifications are as follows: we represent a rise-falling intonation with ‘’ before the word, and a fall-rising contour with ‘’ before the word. We also use double parentheses to detail audible non-speech sounds, while our descriptions of non-verbal behaviour are accorded to tiers, as will be shown in Section 3.2.2 (see also Muntigl, Knight, and Watkins 2012).


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as a factual report of Bud’s leaving and is not built up to convey much affect. For instance, E does not use any explicit stance expressions (e.g., affect verbs, adjectives or adverbs) or elaborate prosody. Suchman et al. (1997) refer to such implicit expressions of affect as potential empathic opportunities. The implication here is that the requirement for the recipient to respond empathically to the teller is not very high. Tellers may, however, provide more detail or accessibility to their trouble in a subsequent turn, especially if it appears that the recipient is having trouble affiliating with the telling. Drawing from Schegloff ’s (2000) work, Stivers (2008) argues that tellers often provide more “granularity” to their descriptions. In providing more granularity or detail of a given event, tellers may, for example, elaborate with words that specify the action taken or use reported speech (Stivers 2008: 44). Returning to example (1), note that E becomes more granular in her telling by depicting Bud’s affective state (“He got- ma:d and went off uhh huh huh”). Thus, after having received no uptake by L, E makes her telling more accessible to L by revealing a possible motive for Bud’s leaving. Various researchers have argued that interactional resources used by recipients such as continuers (“uh huh”, “mm hm”) or even remaining silent may be effective in prompting tellers to develop their affectual stance, thus creating more explicit empathic opportunities for the recipient (Stivers 2008; Suchman et al. 1997). If we return to example (4), the therapist’s continuer (line 4) helps Bonnie to develop and elaborate on her affectual take on “why make it difficult fer people” into a more specific negative judgement about the mother-in-law. More examples of this phenomenon will be shown in Section 4. We have argued in this section that troubles telling is centrally tied up with stance. Further, by conveying their stance, tellers provide recipients with access to their perspective of a given event and, therefore, furnish recipients with empathic opportunities in which recipients may affiliate with some aspect of the troubles telling. 3.2

Empathic responses

To be empathic, it is important that recipients of a troubles telling ratify or confirm that the trouble expressed by the teller is indeed relevant or important and, furthermore, that recipients affiliate with the teller’s trouble, that is, with the teller’s expressions of affectual stance (Stivers 2008). This can be seen by revisiting the first two examples. According to Jefferson, L from example (1) does not align with E as a troubles telling recipient, whereas L from example (2) does. Thus, in (1) L merely acknowledges E’s announcement, but does not affiliate with the import of



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E’s telling. In (2), by contrast, L’s “a h h h h !” and “Oh:: sh:i:t.” convey more than mere acknowledgement: they affiliate with the negative assessment made by E concerning the exorbitant cost of the gold bridge. For these reasons, E’s responses in (2) are considered to communicate empathy with the teller’s trouble, whereas those in (1) do not. For everyday contexts, recipients of troubles tellings are morally obligated to empathically affiliate with the trouble (Heritage 2011). By adhering to these obligations, we uphold a certain moral order and, as a consequence, are able to maintain social relations with others. According to Heritage (2011), however, the requirement to affiliate in these contexts may place respondents in a dilemma, especially when they cannot properly share in these experiences. Furthermore, a trouble may be seen as principally owned by the teller and, for this reason, empathic displays may end up placing epistemic rights or ownership of experience at risk, when not performed adequately. Client-centred therapists are especially sensitive to these issues, as they constantly work at communicating empathy by privileging the client’s construal of experience, while preserving affiliation and relational bonds with the client. Thus, in using this mode of empathic practice, therapists would avoid giving what Greenberg et al. (1993: 119) term “out of mode” responses that position the therapist as an ‘expert’. Examples include interpreting (“I think you’re feeling this way because…”), providing solutions (“you could try doing…”) or disagreeing with the client (“yeah, but…”). To be client-centred, therapists would instead work at conveying to clients their understanding of what clients have said, while at the same time downplaying their own status as ‘knower’. Drawing from Heritage and Raymond’s (2005) work on practical epistemology, this would mean that therapists would downgrade their epistemic rights concerning clients’ experience. There are a host of interactional resources that can function to downgrade one’s status. Common lexicogrammatical resources include epistemic modal expressions (“probably”, “may”) and evidential expressions (“apparently”, “seem”), but also interrogative syntax in which therapists work to explicitly seek confirmation from clients. Non-verbal resources such as nodding may also work empathically, because they display access to and understanding of the teller’s stance (Stivers 2008) and yet do not make any epistemic claims that might ‘intimidate’ the teller. In the following subsections, therapists’ verbal and non-verbal empathic practices will be discussed. Special focus will be placed on the different actions therapists use to display an understanding of clients’ troubles and also how therapists design their actions to avoid making any overt epistemic claims about clients’ experience.

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3.2.1 Verbal practices to display empathy Pudlinski (2005) provides one of the most comprehensive examinations of empathic practices in helping profession contexts. By focussing on how call takers of peer support lines respond to callers’ troubles tellings, Pudlinski identified the following empathic practices: emotive reactions (“oh boy”, “ohh”), assessments (“that’s not fair”), naming another’s feelings (“Aimee Aimee you’re just getting clobbered”) and formulating the gist of the trouble (“medication gave your urge ta smoke, ta come back”). Although each of these practices displays an understanding of the client’s trouble, they do so in very different ways. Whereas the first two – emotive reactions and assessments – seem to affiliate in a non-specific way to the client’s trouble mainly by responding back with the negative emotive import of the telling (i.e., the news is bad), the latter two practices convey a more specific understanding of the troubles telling; as in ‘this is what you’re feeling’ or ‘from what you’ve said, I hear this as being what your trouble is about’. Our examination of psychotherapy talk involving depressed clients shows that therapists draw frequently from the latter two practices identified by Pudlinski, but much less so from the former two. Further, two other empathic practices were identified: formulating the upshot of the client’s talk and co-completing the client’s utterance. In the following subsections, we provide examples of each of these practices used in therapy. In doing so, we also underscore the important role that turn design plays in making these practices empathic and client-centred: Naming someone’s feelings or formulating the gist or upshot of someone’s trouble or co-completing their utterances, while affiliative, do not necessarily privilege the client’s viewpoint. However, by using practical epistemic resources to downgrade their rights to knowledge about client’s experience, therapists are able to build up their response in a way that preserves clients’ ownership of their affectual treatment of troubling events.

3.2.1.1 Naming another’s feelings. When telling their troubles, clients sometimes verbalize their feelings. In responding, therapists can align with these feelings by repeating or slightly reformulating them. Consider (5), taken from a psychotherapy session: (5) Evelyn Case 020.02(01): 01 Ther: °so how’s it been.° 02 (0.7) 03 Eve: mm? (.) °I:? I- (.) I.° I found. I:, (1.1) after 04 the last session I was re:ally like frustrated 05 an:,(0.4) disappointed and I didn’t know what to do 06 with it. (0.3) 07 Ther: ye:s?



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08 Eve: a:nd, I sort of- (1.3) I felt like I’d, (1.4) touch 09 on alotta things an then just walked away from 10 the:m a:nd, 11 Ther: mm h[m:,] 12 Eve: [and] it didn’t really have any shape and 13 didn’t really (.) do anything? an [didn’t] → 14 Ther: [so you seem] → 15 very dissatisfi:ed? 16 Eve: yea:h. (0.4) yeah.

In this example, the client Evelyn expresses a certain stance in which she displays her negative affect (“frustrated an:, (0.4) disappointed”) and her assessment that the last session of therapy was ineffective (“it didn’t really have any shape and didn’t really (.) do anything?”). The therapist then displays her understanding by merging, as it were, Evelyn’s frustration and criticism into one utterance (“so you seem very dissatisfi:ed?”). This kind of practice, we would argue, affiliates strongly with the client, because the therapist is showing here that she is able to access the relevant import of the client’s telling. The therapist also weakens the strength of her claim through the use of two lexicogrammatical resources: the evidential expression “seem” and rising intonation. Thus, by downgrading her own source of knowledge and by inviting Evelyn to confirm her claim, the therapist seeks to preserve Evelyn’s greater rights to know how she felt and the effect that the last session had on her.

3.2.1.2 Gist formulations. Formulations have been receiving increasing attention in CA research on psychotherapy (Antaki, Barnes, and Leudar 2005; Antaki 2008; Hutchby 2005). They generally fall under one of two types: gist formulations that provide a summary of a prior speaker’s talk and upshot formulations that point out the implications of prior talk (see Heritage and Watson 1979). Vehviläinen et al. (2008: 190) suggest a number of functions that formulations serve in psychotherapy talk such as building a case for interpretation, establishing facts, guiding descriptions towards the psychological and managing the progress of the therapy session. The potential empathic function of a formulation lies in its ability to convey an appropriate understanding of the client’s displayed stance. A gist formulation is shown in (6): (6) Sofia Case 304.07(6c):


01 Sofia: wha happen is that we had the funeral ((swallows)) 02 (1.1) an then for example I woul be playin an03 oh I played. (.) during de whole funeral? 04 (0.4)


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05 Sofia: in the street? 06 (1.0) → 07 Ther: you jus wer’nt gunna be there for that. 08 Sofia: n-yeah like em- people were .hhh my father was 09 there, because that’s de way we, (1.3) at that 10 time we used to (0.7) uh::m have the funerals 11 ah home.

In this example, the client Sofia conveys her difficulty as a child not wanting to participate in her father’s funeral. She provides a potential empathic opportunity for the therapist through her emphasis on the activity of “playin” and then by providing further detail of its duration (“during de whole funeral”). The negatively hued stance being developed here should be read with respect to ‘typical’ and ‘acceptable’ behaviours at funerals; that is, as settings, funerals are associated with solemnity and not with acts involving play. After a brief pause in which the therapist does not respond, the client adds more granularity to her telling by mentioning the location of her play: “in the street”. It is here that the therapist then displays an understanding of the client’s stance by producing a gist formulation (“you jus wer’nt gunna be there for that.”). The therapist’s use of “there” not only underscores the relevance of location that Sofia had herself added to her telling – compare Sofia’s playing “in the street” vs. Sofia not being “there” for that [the funeral] – but also posits a connection between Sofia’s telling and the therapist’s formulation that involves Sofia’s motives; that is, her going to the street does not necessarily relate to ‘innocent’ play, but could be motivated by her desire to not be physically present at her father’s funeral. The therapist, therefore, summarizes Sofia’s actions at a deeper level and thus conveys an understanding that guides Sofia’s descriptions towards the psychological.

3.2.1.3 Upshot formulations. We now consider formulations that deliver the upshot, or the implications, of client’s talk. In example (7), after Kristina completes her story, the therapist provides a formulation that affiliates with a difficult situation implicitly conveyed in Kristina’s telling: (7) Kristina Case 014.01(2): 01 Kris: uh because when I went(h) uh. not because mm. w02 when uh (1.4) I graduated from high school? an I 03 wanted to go to university, (0.9) uh. (0.7) no I l04 I ↑left home, (1.2) before that. no. after I05 y’after I (0.4) ye know. when, (0.4) graduated from 06 high school I, (0.8) I went to live with my 07 boyfriend, (0.7)



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08 Kris: for a year, which was (0.6) very unusual. for 09 ((name of country)), then. 10 (1.9) 11 Kris: myeah. 12 (1.2) 13 Kris: so I think also was in a- a part to. 14 (1.0) 15 Kris: to: (.) get awa[y from ] from her, 16 Ther: [to get away,] 17 Kris: .hhh and uhm. (0.6) my father was very very nice. 18 he said I un- I- I understand you cannot stay in 19 thi(h)s situation. so he actually moved me. 20 Ther: hm. 21 Kris: uh he help you know. to take my uh belongings. 22 (1.2) → 23 Ther: so the situation then was pretty intolerable. 24 (1.1) 25 Kris: ah- yes.

Kristina recounts a situation from her youth: a teenager who recently finished high school and who no longer wanted to live at home. Contained within her narrative is an implicit stance in which her home life, and especially her relationship with her mother, is negatively evaluated. Kristina uses various resources that attest to the underlying tension between her and her mother such as the expression “to: (.) get away from from her,” and her use of quoted speech exemplifying how her father empathizes with her (“I understand you cannot stay in thi(h)s situation.”). Although her stance is implicitly formulated and thus only creates a potential empathic opportunity for her recipient, the therapist does convey her understanding by underscoring the implication behind her ‘having to move out’ and her having garnered empathy from her own father: “so the situation then was pretty intolerable.”. Further, the evaluative term “intolerable” is slightly downgraded by the adverb “pretty”, which may index a slight caution on the therapist’s part at having reworked the client’s talk in this explicit manner.

3.2.1.4 Co-completions. Co-completions may work empathically, by showing that the therapist is immediately able to grasp the trajectory of client’s talk. Such a move, however, may come with certain risks, because the therapist’s attempt to complete the client’s utterance may be viewed as too presumptive, inaccurate or as inappropriately overtaking the client’s right of turn. Consider example (8):



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(8) Kristina Case 014.01(1): 01 Kris: ↑not ↑that I dri- i’ll gi- i’ll give you a- a- an 02 (0.8) illostra[tion.] 03 Ther: [ oka]y? 04 Kris: it- ye know from u: (0.6) hm. .hhh e: (0.6) she 05 (0.6)bud this’ll de- it could be generalized but 06 this one is a concrete thing. .hhh she- she would 07 go in uh in winter in her uh. (0.7) nightgown. 08 (0.6) on the balcony to hang the clothes? 09 (0.3) 10 Kris: t- you know to dry? 11 (0.3) 12 Kris: an then uh (.) uhm. she would come back and say 13 well. well we- (.) my brother and I would be very 14 concerned you know you should at least have a coat 15 or something ↑that’s when we were children. 16 (0.4) 17 Kris: an she would say uhm. (0.8) or if she would be ha18 (0.2) angry or something she would say ser- serves 19 you well that I am cold. 20 (1.4) 21 Kris: so I think the guilt feeling is uh, (2.3) °yeah.° → 22 Ther: something that she (0.8) instilled. 23 Kris: .hhh pra- [probably but] → 24 Ther: [in you at lea]st in p[art.] 25 Kris: [bu- ] v- very 26 successfully.

In this excerpt, Kristina provides another illustration of her negative relationship with her mother by recounting an event in which her mother blamed Kristina and her brother for making her risk her health by going outdoors in inappropriate clothing. Kristina builds up a specific stance in which the mother’s unjust attempts to make her children feel guilty is contrasted with the children’s concern for their mother’s well being. This interplay of negatively judging the mother’s behaviour, while at the same time positively evaluating own and brother’s behaviour is done in the following ways: First, through the use of affect terms, she explicitly contrasts her and her brother’s feelings of ‘concern’ with their mother’s ‘angry’ feelings; this contrast is further amplified by adding the context, “↑that’s when we were children” with a sudden prosodic lift in pitch to emphasize their innocence in relation to the responsibility laid on them by their mother. Second, quoted speech (“serves you well that I am cold”) is used to vividly illustrate how the mother cruelly admonishes her children for causing her discomfort. Finally,



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an explicit empathic opportunity is offered to the therapist when Kristina embeds the term “guilt” within an uncompleted clause (“so I think the guilt feeling is uh, (2.3) °yeah.°”). The therapist then shows her understanding of the mother’s practices of blame by completing Kristina’s clause and by beginning to explain what consequences, for the client, her mother’s actions might have had. Although Kristina first responds by downgrading her confirmation (“probably but”), the therapist, in turn, proceeds quickly to downgrade the certainty of this ‘in progress’ claim through the expression “at least in part”. In this way, the therapist is able to preserve the client’s greater rights in knowing how she has been affected by her mother. Kristina then displays her primary rights and access to know by upgrading her confirmation with “very successfully”. 3.2.2 Non-verbal resources to display empathy From our discussion of empathic practices so far, it would appear that therapists patiently wait until clients finish their troubles telling before conveying their understanding or affiliating with their stance. This however is not so. Stivers (2008), for instance, has shown that, during storytelling, story recipients nod in order to claim access to and display understanding of the storyteller’s stance. In this way, nods constitute an important non-verbal resource through which recipients may display a form of minimal empathy with the teller’s viewpoint on an ongoing basis. Though they may be seen as non-specific because they do not explicitly evaluate or express affect, nods are target-specific in that they are sequentially positioned to contiguously respond to a teller’s expressions of stance. In this way, they keep affiliation ‘on track’ throughout, but primarily at salient points of, the teller’s turn. Consider example (9) in which Bonnie begins to tell a story about her sister’s insensitive behaviour following her father’s death. For this example and the ones to follow, we have added additional tiers of non-verbal information to relevant lines of the transcript (see Muntigl, Knight, and Watkins 2012 for a discussion of how we have incorporated non-verbal information such as nods, smiles and body movements into our transcripts). (9) Bonnie Case 305.12(3a): 01 Bonn: and uh. .hhh (0.4) an I think actually I 02 was goin tell ya bout like one sister I remember. 03 (0.5) 04 Bonn: uh:m. 05 (0.9) 06 Bonn: when my father died. (0.4) an this h’s T: fast shallow multiple nods



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07 always sor’ve bothered me too. an I didn’t sor’ve B: shallow double nod → T: fast double nod 08 realize quite how much but it comes into my mind. so T: shallow nod 09 it must’ve bothered me more than I though[t. .hhh] B: bobs head back → T: slow nod-----------------------------> 10 Ther: [hm. ] 11 Bonn: uhm:. (0.9) ↑maybe i’ve had a habit of puttin all my 12 things on [ho:ld(h) hehheh]heh ye know. well=mebe B: nod → T: slow multiple nods-------------------> → 13 Ther: [mm hm. ] 14 Bonn: this is par’a my prob[lem. .hhh] T:----------------------------> → 15 Ther: [ yea:h. ]

Bonnie conveys two main stances in this example: The first is affectual in which she claims that her sister’s actions had bothered her; The second is implicit and relates more to a general criticism of self in which she tends to avoid talking about issues that trouble (i.e., bother) her. The first stance of ‘feeling bothered’ gets amplified through an adverb of frequency “always sor’ve bothered me too” and through an adverbial expression that highlights an implied relevance in having felt that way (“it must’ve bothered me more than I thought”). Bonnie then designs the rest of her turn as a ‘realization’ that is prefaced by a distinct lift in pitch (“↑maybe”): This realization then takes the form of Bonnie having a habit of putting ‘her feelings’ on hold with the further implication that this kind of behaviour may be a problem. The therapist’s nods sequentially line up with Bonnie’s stance displays: These nods are in direct response to Bonnie’s first mention of her ‘bothered’ feeling (line 7), to her mention of the degree to which she is bothered (line 9) and finally to Bonnie’s realization that she tends to put her feelings on hold (line 12). We would also note that, towards the end of Bonnie’s realization of how her feeling bothered her and how her not doing anything about it may be a problem, the therapist produces two upgraded acknowledgement tokens (“mm hm”; “yea:h”). The therapist’s nods, coupled with her acknowledgements appearing towards the end of Bonnie’s turn, display a heightened level of understanding and empathy with Bonnie’s salient displays of affect and evaluations of her inaction. This demonstrates that empathic displays are an ongoing, locally produced and collaborative achievement in which the client creates empathic opportunities



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through stance displays and the therapist, in turn, responds by displaying access to and understanding of the conveyed stance. Non-verbal resources such as nodding also play an important role in conveying empathy when clients disagree with a therapist’s formulation of client’s prior talk. In these contexts, it was found that nods conveyed token affiliation of the client’s diverging view and thus helped to privilege the client’s view over the therapist’s (Muntigl, Knight, and Watkins 2012). Consider example (10), in which Paula discusses the pros and cons of having roommates. (10) Paula Case 312.02(08) (from Muntigl et al. 2012: 18–19): 01 Paula: like I ha- (.) found it difficul:t sometimes (.) 02 to::, (2.2) relate to them, and (0.3) their, er03 (2.4) their problems hh He he he.hh and i- e04 (0.8) it worked the opposite °way too I guess.° 05 Ther: you were just (.) on different wavelengths 06 Paula: ye- yeah. 07 [(0.3 )] [P: nod ] [T: fast multiple nods ] 08 Paula: but it- (.) like, (0.7) I guess once in a while in 09 between we kinda struck it. ehuh he(.h)h. → T: deep nod, smile 10 [( 2.3 )] → [T: double nod---> ]

Paula gives voice to her general difficulty in relating to roommates and their problems, but she also concedes that her roommates may have felt similarly with regard to her own problems. In response, the therapist utters a gist formulation that underscores the differences of viewpoint between them (“you were just (.) on different wavelengths”). Paula’s initial reaction is agreement and is followed by mutual displays of nodding between her and the therapist. What first appeared as agreement, however, quickly turns into disagreement when Paula proceeds with a but-prefaced qualifying comment that “once in a while in between we kinda struck it.” In effect, Paula transforms the therapist’s negative evaluative take on her relationship with roommates to a more positive one. Rather than overtly respond, the therapist waits for Paula to develop her contrasting stance before displaying affiliation through a series of nods and a smile (lines 9–10).5 Further, empathy is



5. Note that by smiling in response to Paula’s laughter, the therapist has also ensured that the important therapeutic work going on is not subverted by the interactional project of affiliating. Research targeting various professional formats has shown that reciprocating client laughter,

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conveyed through these non-verbal actions because they display access to and acceptance of the client’s divergent position. It is thus by nodding and smiling that the therapist lets go of her own prior position, thereby privileging the client’s view of the relationship between her and her roommates. 4. Enlisting practices to convey empathy during client storytelling In the previous sections, we have illustrated some common interactional practices (verbal and nonverbal) through which therapists display empathy with a client’s stance during troubles tellings. In this section, we examine how these resources operate synergistically to create and build up empathic connections with a client. From our examination of situations of client storytelling, we noted that therapist empathic practices would tend to unfold in the following manner: First, therapists would often display access to the client’s stance by nodding, thus displaying a sensitivity to the empathic opportunities realized in the client’s talk. Second, therapists would withhold more explicit forms of empathic display, allowing the client to elaborate their stance in more detail or ‘become more granular’. In this way, therapists worked to co-manage more explicit empathic opportunities in which to affiliate. Third, following a more elaborated client stance, therapists would offer a more explicit display of empathy, often by formulating client’s talk or naming client’s feelings. This often resulted in mutual displays of affiliation between the speakers that involved reciprocating nods, smiles or acknowledgement/ agreement. The empathic unfolding, as outlined above, is illustrated in (11). The excerpt has been segmented into three parts to illustrate the three phases of empathic development between therapist and client. Just prior to this extract, the client Kristina had been discussing her quarrels with her husband from the preceding week. After having noted that she cannot recall anything, Kristina went on to recount the following occasion in which her husband reacted to her suggestion that he move over on the sofa with a threatening outburst:


particularly during talk of problems, has potential negative implications because it may defer or even cut off further elaboration or reflection of a relevant problem (Bänninger-Huber 1992, 1996; Haakana 2001). Thus, by not sharing in the laughter, the therapist’s smile works empathically to display access to the client’s stance while remaining at an ‘appropriate’ distance from it.


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(11) Kristina Case 014.13(1): 1. Affiliating with client’s stance during storying 01 Kris: uh:. (0.5) except uh:. a remark? of my husband K: turns head towards T, looks down 02 which I found also very. uh offensive. . . . 13 Kris: let’s say I would ask him to move in de sof- move on 14 de sofa little bit. (0.2) more to the s- something. K: shallow multiple nods→ T: multiple nods 15 you kno[w uh:m,] totally (1.2) uh (1.1) °like° K:------> K: holds hand up T: double nod 16 Ther: [mm hm,] 17 Kris: everyday talk? 18 (1.1) T: fast shallow multiple nods 19 Kris: an he- he would uh. get- he- he got upset, 20 (1.2) 21 Kris: an he said oh uh:. (3.2) if I am::. (1.1) sending 22 him: back to work? K: looks at T 23 (0.6) 24 Kris: like let’s say in the evening. instead of watching → T: slow nod-----------------> 25 television or something dat I would uh be sending. → T: shallow double nod 26 (0.4) 27 Kris: uh he said. uh should I go: uh::m. (1.4) back K: bobs head back 28 (0.4) to translate or. to de computer whatever, an:. → T: slow nod

2. Eliciting more granularity from client 29 an then he said OR I will. (0.8) K: holds hand up 30 take an axe and will: chop(h) everything into pieces. K: flips hand back. K: chops fist across → 31 (0.5) → 32 Ther: °°hm.°° → T: nod



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33 Kris: so. so I don’t really know what to say (anaymore.) 34 (1.1) 35 Kris: mm. occasions °like that.° 36 (0.8)

3. Explicit empathic display to foster stronger mutual affiliation → 37 Ther: so sounds like that kina s:topped you cold it kina. → T: throws fist down 38 (0.7) K: bobs head back, shakes head 39 Kris: [absolutely. yeah.] → 40 Ther: [almost like kina .hhh ] → T: sharp inbreath, bobs head back → 41 Ther: hold your (0.6) breath [an not know wh]at ta hm. T: slow nod 42 Kris: [mm hm. ] K: shallow nod 43 (1.0) 44 Kris: zis horrible. it’s really horrifying. K: bobs head back, lowers eyebrows, shakes head

At the beginning of this excerpt, Kristina launches into a story with the aim of providing an example of how her husband has been offensive towards her. Kristina orients the therapist into the particulars of the story by telling her what originally prompted the husband to become offensive (she asked him to move over on the sofa) and by illustrating some of his responses (“if I am::. (1.1) sending him: back to work?”; “should I go: uh::m. (1.4) back (0.4) to translate or. to de computer whatever”). By listing these responses, however, Kristina has not yet seemed able to fully portray the extent of the husband’s anger and what was offensive about his actions. Thus, Kristina has so far only provided potential empathic opportunities for the therapist that would warrant responsive nods (lines 24, 25, 28), but perhaps not an explicit verbal empathic display. But as Kristina proceeds with her story, she then reveals the third response from the husband – the clincher – thus producing a climax to her story of a potentially serious, violent event (“I will. (0.8) take an axe and will: chop(h) everything into pieces.”). Now, although such a ‘shocking’ disclosure of an axe wielding person chopping up the furniture into pieces would most likely receive upgraded emotive responses from story recipients in everyday contexts, the therapy setting is different. In other words, therapeutic business does not leave much room for therapists becoming shocked at clients’ stories. Instead, what would be more in-line with doing therapy would be seeking to know how a given situation or



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confrontation impacted upon the client, how did it make her feel? Thus, in order to realize this second phase of the unfolding client narrative, the therapist would need to elicit more granularity from the client in order for her to more fully develop her affectual stance. One common practice to solicit more detail from clients would be to withhold from speaking or provide a continuer (Muntigl and Hadic Zabala 2008). The therapist makes use of these practices by first delaying her responses and then through a quiet-voiced continuer (“°°hm.°°”) produced in accompaniment with a single moderate nod. As a result, Kristina offered more granularity to her description by describing her husband’s effect on her (“I don’t really know what to say (anaymore.)”). This extra detail from the client in which she provides more specific access to her affectual stance leads the therapist into producing a full-fledged empathic response, which constitutes the third phase of the story telling activity. What is interesting is that the therapist provides explicit detail of how she understands Kristina’s reaction to the husband’s act. Her use of metaphors such as “s:topped you cold” and “hold your (0.6) breath”, her deep inbreath and her ‘clenched fist’ gesture depicting the fall of the axe provide the client, in turn, with explicit access to how the therapist understands the effect of the husband’s offense on Kristina. By upgrading the detail of the event in this manner, the therapist may be taking a risk in that it may be demonstrating greater or ‘expert’ access to Kristina’s feelings. But, several points may speak against that: First, the therapist repeatedly downgrades her formulations with “kina” and “almost” and, second, she receives affiliative displays from Kristina during her turn-in-progress: upgraded confirmation (line 39), acknowledgment (line 42) and a nod (line 42). Thus, by continuously monitoring Kristina’s affiliation, the therapist may be encouraged to continue with her detailed expressions of empathy. As a third point, we note that the therapist’s responses fully align with Kristina’s viewpoint; that is, the expressions “stopped you cold” and “hold your breath” express Kristina’s emotive reactions and do not, in any way, reveal how the therapist may have experienced another’s actions in this context.6 Thus, the therapist is able to build on Kristina’s emotive reactions of her personal event and, in this way, preserve her ownership of that experience.


6. For the sake of comparison, a response such as “Oh:: sh:i:t.” would have revealed not only the therapist’s understanding of the husband’s offensive remark, but also her emotional response. By refraining from doing this, the therapist is able to keep a certain emotional distance from the husband’s remarks and, thus, allow the focus of talk to remain on the client.


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5. Conclusions The term ‘helping professions’ implies a certain kind of relationship between professionals and their clients: ‘caring’, ‘supportive’, ‘understanding’, ‘affiliative’ are just some adjectives that capture the essential qualities of this kind of working relationship. Such relationships are constituted in the kinds of verbal and non-verbal practices we have exemplified in this paper; in particular we have exhibited how psychotherapists working within a client-centred professional format achieve affiliation with their clients by responding empathically to their talk about problems. We have also suggested that different helping professions may draw from different interactional resources to construct a sense of understanding and affiliation with clients’ troubles tellings. Within this interaction type, although it may at times be beneficial for crisis line operators or physicians to engage with the client or patient through strong forms of affiliation such as sympathy, client-centred psychotherapists adopt communicative practices that refrain from displaying sympathy. In this kind of professional format, the therapist’s job is not to show the client how she or he has been emotively affected by the client’s trouble. Rather, the therapist operates to display an intricate understanding of the client’s concerns, but without emotionally identifying with these concerns and without appearing as someone who understands the client’s trouble better than the client. This is, briefly put, the guiding principle behind Rogerian empathy. Our larger aim was to show how a Rogerian take on empathy is put into practice by client-centred therapists. By drawing from the theoretical/empirical framework of CA (Schegloff 2007; Stivers 2008), we were able to show how clients create empathic opportunities by giving therapists access to their emotions, attitudes and judgements through displays of stance, and how therapists orient to, and take up, these opportunities through a range of interactional resources, verbal and non-verbal. By providing a detailed turn-by-turn analysis of therapy-client interactions, it becomes clear that, as McLeod (1999) has already argued, empathy is not simply a specialized technique or a one-off response from the therapist. Instead, empathy is ongoing and its continuous display is sensitive to and dependent on client’s talk; that is, clients need to articulate and develop their affectual stance, to create sequential points of empathic engagement, in order for therapists to display a relevant understanding of the client’s trouble. Achieving empathy, therefore, is a co-ordinated activity in which client displays of affectual stance and therapist empathic responses occur in synchrony. Thus, by nodding exactly when clients display their stance, it may become more easily inferable that therapists have access to and understand the attitudes being conveyed throughout the story. Similarly, by formulating the client’s trouble, therapists need to select the relevant features



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of the client’s stance and package them in a way that clients will recognize as ‘their own’. Thus, empathic achievements not only require ongoing collaborative work from both participants, but also an unwavering regard and appreciation of the client’s originally formulated point of view. Successful empathic practices, we would argue, are able to balance these requirements.

Acknowledgements This research is supported by a standard research grant from the Social Sciences and Humanities Research Council of Canada (410-2009-0549).

References Antaki, Charles. 2008. “Formulations in Psychotherapy.” In Conversation Analysis and Psychotherapy, ed. by Anssi Pärakylä, Charles Antaki, Sanna Vehviläinen, and Ivan Leudar, 26–42. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511490002.003 Antaki, Charles, Rebecca Barnes, and Ivan Leudar. 2005. “Diagnostic Formulations in Psychotherapy.” Discourse Studies 7 (6): 627–647. DOI: 10.1177/1461445605055420 Bänninger-Huber, Eva. 1992. “Prototypical Affective Microsequences in Psychotherapeutic Interactions.” Psychotherapy Research 2 (4): 291–306. DOI: 10.1080/10503309212331333044 Bänninger-Huber, Eva. 1996. Mimik, Übertragung, Interaktion: Die Untersuchung affektiver Prozesse in der Psychotherapie. Bern: Hans Huber. Barrett-Lennard, Godfrey. 1981. “The Empathy Cycle: Refinement of a Nuclear Concept.” Journal of Counselling Psychology 28: 91–100. DOI: 10.1037/0022-0167.28.2.91 Biber, Douglas, and Edward Finegan. 1989. “Styles of Stance in English: Lexical and Grammatical Marking of Evidentiality and Affect.” Text 9 (1): 93–124. Bruner, Jerome. 1986. Actual Minds, Possible Worlds. Cambridge: Harvard University Press. Greenberg, Leslie, Laura Rice, and Robert Elliot. 1993. Facilitating Emotional Change. New York: The Guildford Press. Haakana, Markku. 2001. “Laughter as a Patient’s Resource: Dealing with Delicate Aspects of Medical Interaction.” Text 21: 187–220. Heritage, John. 2011. “Territories of Knowledge, Territories of Experience: Empathic Moments in Interaction.” In The Morality of Knowledge in Conversation, ed. by Tanya Stivers, Lorenza Mondada, and Jakob Steensig, 159–183. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511921674.008 Heritage, John, and Geoffrey Raymond. 2005. “The Terms of Agreement: Indexing Epistemic Authority and Subordination in Talk-in-Interaction.” Social Psychology Quarterly 68 (1): 15–38. DOI: 10.1177/019027250506800103 Heritage, John, and Rod Watson. 1979. “Formulations as Conversational Objects.” In Everyday Language: Studies in Ethnomethodology, ed. by George Psathas, 123–163. New York: Irvington.



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Hutchby, Ian. 2005. “‘Active Listening’: Formulations and the Elicitation of Feelings-Talk in Child Counselling.” Research on Language & Social Interaction 38 (3): 303–329. DOI: 10.1207/s15327973rlsi3803_4 Jefferson, Gail. 1988. “On the Sequential Organization of Troubles Talk in Ordinary Conversation.” Social Problems 35 (4): 418–442. DOI: 10.2307/800595 Jefferson, Gail. 2004. “Glossary of Transcript Symbols with an Introduction.” In Conversation Analysis: Studies from the First Generation, ed. by Gene H. Lerner, 13–31. Amsterdam: John Benjamins. DOI: 10.1075/pbns.125.02jef Labov, William. 1972. Language in the Inner City. Philadelphia: Pennsylvania University Press. Labov, William, and Joshua Waletzky. 1967. “Narrative Analysis: Oral Versions of Personal Experience.” In Essays on the Verbal and Visual Arts, ed. by June Helm, 12–44. Seattle: University of Washington Press. McLeod, John. 1999. “A Narrative Social Constructionist Approach to Therapeutic Empathy.” Counselling Psychology Quarterly 12 (4): 377–394. DOI: 10.1080/09515079908254107 Muntigl, Peter, Naomi K. Knight, and Ashley Watkins. 2012. “Working to Keep Aligned in Psychotherapy: Using Nods as a Dialogic Resource to Display Affiliation.” Language & Dialogue 2 (1): 9–27. DOI: 10.1075/ld.2.1.01mun Muntigl, Peter, and Loreley Hadic Zabala. 2008. “Expandable Answers: How Clients Get Prompted to Say More During Psychotherapy.” Research on Language and Social Interaction 41 (2): 187–226. DOI: 10.1080/08351810802028738 Pudlinski, Christopher. 2005. “Doing Empathy and Sympathy: Caring Responses to Troubles Telling on a Peer Support Line.” Discourse Studies 7: 267–288. DOI: 10.1177/1461445605052177 Rennie, David L. 1998. Person-Centred Counselling: An Experiential Approach. London: Sage. DOI: 10.4135/9781446279854 Rogers, Carl R. 1951. Client-Centred Therapy. London: Constable & Robinson. Rogers, Carl R. 1957. “The Necessary and Sufficient Conditions of Therapeutic Personality Change.” Journal of Consulting Psychology 21 (2): 95–103. DOI: 10.1037/h0045357 Ruusuvuori, Johanna. 2005. “‘Empathy’ and ‘Sympathy’ in Action: Attending to Patients’ Troubles in Finnish Homeopathic and General Practice Consultations.” Social Psychology Quarterly 68 (3): 204–222. DOI: 10.1177/019027250506800302 Ruusuvuori, Johanna. 2007. “Managing Affect. Integration of Empathy and Problem Solving in Two Types of Medical Consultation.” Discourse Studies 9 (5): 597–620. DOI: 10.1177/1461445607081269 Sacks, Harvey, Emanuel A. Schegloff, and Gail Jefferson. 1974. “A Simplest Systematics for the Organization of Turn-Taking for Conversation.” Language 50: 696–735. DOI: 10.2307/412243 Schegloff, Emanuel A. 2000. “On Granularity.” Annual Review of Sociology 26: 715–720. DOI: 10.1146/annurev.soc.26.1.715 Schegloff, Emanuel A. 2007. Sequence Organization in Interaction: A Primer in Conversation Analysis, Vol. 1. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511791208 Stivers, Tanya. 2008. “Stance, Alignment and Affiliation during Storytelling: When Nodding is a Token of Affiliation.” Research on Language and Social Interaction 41 (1): 31–57. DOI: 10.1080/08351810701691123



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Suchman, Anthony L., Kathryn Markakis, Howard B. Beckman, and Richard Frankel. 1997. “A Model of Empathic Communication in the Medical Interview.” Journal of the American Medical Association 277 (8): 678–682. DOI: 10.1001/jama.1997.03540320082047 Vehviläinen, Sanna, Anssi Peräkylä, Charles Antaki, and Ivan Leudar. 2008. “A Review of the Conversational Practices of Psychotherapy.” In Conversation Analysis and Psychotherapy, ed. by Anssi Peräkylä, Charles Antaki, Sanna Vehviläinen, and Ivan Leudar, 188–197. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511490002.012



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The interactional accomplishment of feelingstalk in psychotherapy and executive coaching Same format, different functions? Eva-Maria Graf and Joanna Pawelczyk

Feelings-talk is considered an important interaction type in many helping professions as the ‘helping’ element often involves various forms of engagement in emotional work. In this chapter we identify and critically assess the interactional forms and functions of feelings-talk in Relationship-focused Integrative Psychotherapy and Emotional Intelligentes Coaching. By adopting methods and insights from Conversation Analysis, (Critical) Discourse Analysis and Interactional Sociolinguistics, we demonstrate how the endemic feature of psychotherapy, i.e. feelings-talk, emerges as an interactionally accomplished project as psychotherapist and clients work through the clients’ personal issues. We then show how the interactional context of executive coaching both relies on, and further extends, the psychotherapeutic feelings-talk strategies to address clients’ professional dilemmas. Besides emancipatory goals such as fostering clients’ self-enhancement, clients’ emotions are thereby partly functionalized for organizational goals. Feelings-talk can thus be regarded as a constitutive feature of both helping professional formats addressed in this paper, yet with different professional goals.

1. Feelings-talk – interaction type across helping professions? ‘Feelings-talk’ (Pawelczyk 2011) constitutes an important interactional format across many helping professions. As conceptualized in this chapter , feelings-talk relates to various aspects of emotional work that transpire in the interaction between a professional (practitioner) and an individual (client, patient, etc.) who is in need of some kind of assistance. Even though the assistance may involve providing an individual with (mainly) factual information, in many of the helping professions it refers to explicitly and/or implicitly addressing and working with and through the clients’ various emotions to accomplish relevant personal



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and professional goals. For instance, doctor-patient interaction tends not to be characterized only in terms of a factual exchange such as diagnosing, but it also incorporates aspects of emotionality to facilitate the communication between a professional and client who finds himself/herself in a potentially face-threatening/ asymmetrical setting (e.g. Fiehler 2004 lists ‘responding to patients’ manifestation of emotions or emotional experiences’ as one emotional processing strategy for doctors; see also Lalouschek 2004). In this affect-welcoming setting, the patient is encouraged to give voice to his/her lived experiencing of illness.1 Importantly, different helping professions draw on different interactional resources to do feelings-talk while, concurrently, the discursive unfolding of feelings-talk is molded by different types of professional-client relations that account for “differing participation frameworks” (Drew and Heritage 1992: 22) (see e.g. the therapeutic/ coaching alliance discussed in this chapter or Aksu (this volume) on the special relationship between supervisor and supervisee as two experts from the same or similar professional field). In this paper we look into the forms and functions of feelings-talk in two important ‘helping’ contexts, namely psychotherapy and executive coaching.2 Feelings-talk is an endemic characteristic of psychotherapy, where emotional healing occurs through communicative practices such as ‘self-disclosure’ and ‘communication of emotions’ (Pawelczyk 2011; Voutilainen et al. 2010). The psychotherapist’s elicitation of clients’ experiences of stressful and traumatic events fulfills important functions, for instance facilitating clients’ new appraisals of the stressful situation or providing comfort and emotional support. In this sense a psychotherapeutic interaction emerges as a professional model of performing emotional work showcasing multiple modes of communicating emotional experience. The therapeutic culture of late modern society (Giddens 1991; Furedi 2004) highlights talking through things and being open in relationships and prioritizes emotions in everyday interaction but also – increasingly often – in professional settings (cf. Pawelczyk and Graf 2011). As a consequence, feelings-talk has also entered

1. However, creating discursive space for patients’ emotionality as regards their health issues is more a feature of psychosomatic or integral medicine rather than traditional medicine, where patients’ emotionality is de-regulated or problematized (Johanna Lalouschek, personal communication).


2. The comparison of psychotherapy and (executive) coaching as regards the discursive realizations of feelings-talk is particularly rewarding given that – on the one hand – coaching has developed out of the practical application or translation of therapeutic interventions in the managerial context, while on the other hand it is of utmost importance for the self-image and acceptance of coaching in the managerial realm to clearly distance its practice from therapeutic connotations.


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the managerial or organizational realm (Fineman (ed.) 2002; Graf 2012; Schulz 2013; Graf in prep.). Despite the entrepreneurial and business-oriented character of executive coaching with its focus on clients’ professional and career-oriented issues, clients’ verbalizations of emotional experience constitute a central element in coaching interaction (Schulz 2013 talks about the ‘psycho-managerial complex’ in this context). Executive coaching thereby selectively draws on various therapeutic practices of communicating emotions in accordance with its professional goals. It is hypothesized that feelings-talk in coaching not only serves clients’ self-reflection and self-enhancement, but is also systematically employed to enhance clients’ understanding of their business-related issues and thus to improve their professional performance. In order to critically discuss the particular form(s) and function(s) of feelings-talk in the two professional formats, we apply an integrative qualitative analysis. This discursive approach integrates ideas from Conversation Analysis, (Critical) Discourse Analysis and Interactional Sociolinguistics (cf. van Dijk 2001; Pawelczyk 2011) and facilitates – in its multi-layered design – both the analysis of the local interactive business at hand and the discovery of more global discursive and social practices which underlie and at the same time build the discursive contexts under scrutiny here. Data examples from authentic psychotherapeutic and coaching sessions are used to illustrate how therapists and coaches successfully exploit clients’ experiences of emotional distress for their respective professional goals. 2. Emotions in professional discourse Although clients’ emotional experiences influence any type of professional interaction to some degree, therapy and coaching are professional contexts where the clients’ emotionality takes center stage and constitutes the raw material on which the professional work rests. Emotions and emotional work then occupy the central position in psychotherapeutic practice (e.g. Greenberg and Safran 1987; Greenberg and Paivio 1997; Pawelczyk 2011; see also Muntigl et al. in this volume on empathic practices in client-centered psychotherapy). Despite numerous psychotherapeutic traditions and schools, working with and through clients’ emotions appears to be the main tool through which the desired change can be accomplished (cf. Greenberg and Safran 1987; Voutilainen 2012).3 Indeed the change concerns the transformation of one’s beliefs, personal convictions and life



3. Scholars investigating the practices of psychotherapy from a CA perspective have identified ‘recognition of the client’s emotion’ as a candidate for a common practice across psychotherapeutic approaches (Pawelczyk 2011: 160).

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experiences. Thus the old, predictable, well recognizable and schematic patterns of thinking, behaving and experiencing are granted new meanings and significance (cf. Greenberg and Safran 1987; Czabała 2006). In other words, the client – as a result of the therapeutic endeavor – is (ideally) able to look at familiar life situations and experiences with fresh insight gained through various types of emotion work performed in the context of the unique alliance between him/her and the therapist. The very process of gaining transformation must enlist deep emotions to be fully completed and successful. In this sense emotional work emerges as one of the curative and emancipatory factors in psychotherapy. As Voutilainen et al. (2010) succinctly summarize, even the classical psychotherapeutic traditions (e.g., psychoanalysis, cognitive therapy) tend to subscribe to the view “that the processes through which the therapeutic change takes place might not have so much to do with gaining new insights or rationality but with new experiences of emotional expression and response in the therapeutic relationship” (2010: 86). The authors show in their data how “cognition/consciousness-centered and emotion-centered therapeutic actions” (2010: 104) are in fact contingent on one another (see also Voutilainen 2012: 235). This is to say that cognition involves emotion and emotion involves cognition (cf. Damasio 1994; Greenberg and Paivio 1997). Different types of emotional work transpire in a psychotherapeutic interaction. Analyzing interactions within cognitive-constructivist psychotherapy, Voutilainen et al. (2010) made a distinction between two types of responses by psychotherapist to the client’s emotional experience: recognition (emotional responsiveness) and interpretation. Being very much intertwined in the actual psychotherapeutic work, recognition refers to the therapist’s acknowledging the client’s experience as real and valid while interpretation “suggests that there is something else involved in the patient’s experience than what the patient herself overtly brings forward, but it also works to recognize the patient’s experience” (Voutilainen et al. 2010: 102). According to Voutilainen et al. (2010), the therapist’s empathic response constitutes a necessary foundation for more cognitive, interpretive actions to be carried out. Yet, the therapist’s engagement in the client’s emotional work involves reliance on a number of specific interactional strategies that can generally be subsumed under the two important conversational acts of responding and interpreting. Communication of emotion in the context of psychotherapeutic interaction involves constructing, doing, experiencing, eliciting and validating the client’s emotions (Pawelczyk 2011: 151). In addition to the proper therapeutic context, emotions are en vogue in today’s corporate and organizational world, too, which – according to Fambrough and Hart (2008: 741) – can be described as a “pro-emotional organizational arena”.



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As part of a larger socio-cultural movement of late modernity that celebrates the reflexivity of the self (Giddens 1991), ‘soft capitalism’ (Thrift 2005) or ‘emotional capitalism’ (Illouz 2008) not only introduces therapeutic discourse into all realms of modern life and generally blurs the boundaries between the public and the private, but also represents the prevailing ideological boundaries within which work life is organized in the 21st century. Workers’ emotionality has therein been commodified; emotions have been transformed into a marketable product that needs to be managed, adapted, controlled and strategically applied to unleash the full potential of human resourcefulness and thus to achieve peak performance (cf. Hochschild 1983; Fineman 2000; Schulz 2013). A professional site of growing importance in which both releasing and managing workers’ emotions is put center stage is coaching (Graf in prep.; Hefferon 2013; Schulz 2013). Coaching or, to be more precise, executive or management coaching, is defined as an organization-based and -funded Human Resource Management intervention that aims to help “individuals regulate and direct their interpersonal and intra-personal resources to better attain their goals” (Grant 2006: 153). These goals center on questions of leadership, managerial effectiveness and peak performance in the context of executive clients’ specific personal and subjective predispositions and situations. Coaching is (mainly) practiced in a one-on-one relationship between a coach working as a facilitator and a client with managerial responsibility who meet for several sessions to initiate and support the client’s self-reflection and self-learning, and thus change, as regards these (work-related) primary concerns (see also Sator and Graf, this volume). Concurrently, the intimacy of the coach-client dyad offers managers the possibility to verbalize less dominant discourses and stage less dominant identities (cf. Graf 2012: 39ff.) by topicalizing negative emotions such as insecurity or fear. Having the opportunity to freely address these feelings is experienced as emancipatory and agentive by executive clients. A core concept to gaining executives’ awareness and ensuing domination of their emotionality is ‘Emotional Intelligence’.4 According to EI in dealing with one’s emotions “…the problem is not with emotionality, but with the appropriateness of emotion and its expression” (Goleman 1995: xv). Emotional intelligence therefore promotes a controlled and conscious dealing with emotions according to the requirements of the situation instead of giving free reign to feelings (Goleman 1995; Sieben and Wettergren 2010). With the help of EI, emotions and competent management thereof have been turned

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4. EI was originally put forth by Salovey and Meyer (1990). Yet, it gained its immense popularity in both the psy-discourses and the managerial discourse through David Goleman’s books such as Emotional Intelligence. Why it can matter more than IQ (1995) or Working with Emotional Intelligence (1998).


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into a measurable entity and product (cf. Fineman 2000: 111) and – in the world of the organization and management – into an essential skill and success factor in the twenty-first-century workplace (cf. Lewis and Simpson 2007: 5). To conclude, given that “[e]motions are central to human experience […] an appreciation of their role in the process of change is an essential component of comprehensive coaching interventions (Davis 2005: 64)”. 3. Two professional helping contexts: Relationship-focused Integrative Psychotherapy and Emotional Intelligentes Coaching5 In what follows we give a short overview of the action-guiding concepts of the two helping professional formats whose discursive realization of ‘feelings-talk’ we analyze here: Relationship-focused Integrative Psychotherapy and Emotional Intelligentes Coaching (Emotional Intelligent Coaching). As regards Relationship-focused Integrative Psychotherapy, the ‘integrative’ aspect of this psychotherapeutic protocol refers to the process of integrating the client’s fragmented personality, i.e. “it is the process of making whole: taking disowned, unaware, unresolved aspects of the ego and making them part of a cohesive self ” (Erskine and Trautmann 1993: 1). It also underlines the integration of theory to best address the client’s needs. Relationship-focused Integrative Psychotherapy is premised primarily on four theoretical perspectives: transactional analysis, Gestalt therapy, client-centered therapy and behaviorism and as such “attends seriously to what has been observed by all the major schools” (Wachtel 1990: 235). It reflects the current eclecticism in psychotherapy, yet concurrently “provides internally compatible understandings of personality functioning, change, and technique” (Frank 1991: 540). In turn, the concept of relationship as a contactful and interpersonal entity constitutes the cornerstone of Integrative Psychotherapy. As Erskine (1982: 316) states, “healing is in the relationship”. This contact-oriented, relationship-focused psychotherapy is based on the methods of enquiry, attunement and involvement (see Voutinlainen 2012, who talks about ‘investigative’ and ‘experiential’ emphases as unifying traits in psychotherapy). Most importantly, Integrative Psychotherapy practitioners believe that “change comes and remains solid as clients make their own meaning out of their own internal and external experiences” (Clark 1996: 313f.; see also Tolan 2003).



5. Emotional Intelligentes Coaching is a business coaching approach practiced in Germany, the original data that forms the basis for the analysis is thus in German.

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As regards Emotional Intelligentes Coaching, this executive coaching format is premised on the core competencies of Emotional Intelligence, i.e. self-awareness, self-regulation, self-management, empathy and relationship management (Goleman 1995, 1998). It also integrates concepts and interventions from two therapeutic approaches, the Internal Family Systems Model (IFS) by Richard Schwartz (1995) and Hakomi Body-Centered Psychotherapy (Kurtz 1990). While “IFS represents a new synthesis of two paradigms. One is called the multiplicity of the mind – the idea that we all contain many different beings. The other is known as systems thinking” (Schwartz 1995: 9), Hakomi stresses the shift of the (therapeutic) focus from talk towards experience and further from experience to the organization of experience (cf. Kurtz 1990: 22). The coaches’ overall professional goal is to (re-)direct their clients’ attention from a cognitive, facts-oriented approach to an experiential, emotion-oriented access to their questions and concerns and to raise their self-awareness and self-reflection, thus strengthening their self-regulation (as regards their emotional expression etc.). The underlying and action-guiding core assumption thereby is that very often inter-personal problems in the clients’ professional lives (as an executive) originate from intra-personally conflicting feelings, emotions and attitudes. (Re-)focusing clients on their emotions is achieved via a particular inventory of feelings-talk enhancing strategies and should be embedded in a non-judgmental, open and well-coming relationship with their clients, i.e. a sincere coaching alliance. Concurrently, the clients’ (paying) organization is always (implicitly) present and frames the emotional approach, given that Emotional Intelligentes Coaching operates under the name of ‘executive coaching’, succinctly defined by Kilburg (2000: 65f.), as … a helping relationship formed between a client who has managerial authority and responsibility in an organization and a consultant who uses a wide variety of behavioral techniques and methods to assist the client to achieve a mutually identified set of goals to improve his or her professional performance and personal satisfaction and consequently to improve the effectiveness of the client’s organization within a formally defined coaching agreement.

4. Interactional accomplishment of feelings-talk in psychotherapy and executive coaching – data analysis and interpretation 4.1

Data



This section presents how feelings-talk features in the interactions between therapist/client and coach/client in terms of its forms and functions. To this end recordings of actual psychotherapeutic sessions (for more details see Pawelczyk

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2011) and coaching sessions (for more details see Graf in prep.) are analyzed. The therapeutic data is taken from a corpus of 65 hours of recorded therapy sessions collected during fieldwork at two residential Relationship-focused Integrative Psychotherapy workshops in the US and Sweden (Erskine and Moursund 1988; Erskine and Trautmann 1996; Moursund and Erskine 2004). The sessions were conducted by the same male psychotherapist, who talked individually with twenty-five clients (five males and twenty females) but in the presence of other clients. The authentic (German) coaching data is taken from a corpus of 9 video-taped coaching processes between one coach and one client; each process contains between 3 to 8 sessions with one session lasting approximately 2.5 hours. All in all, the material amounts to more than 100 hours of coaching interaction. The coaching was executed by one male and one female coach and their male and female clients, all executives from internationally operating organizations from the banking, insurance and consulting sector. 4.2

Types of feelings-talk: ‘Creating the therapeutic/coaching alliance’ and ‘accessing and reorganizing clients’ emotions’

Our analysis will focus on two types of feelings-talk that have been identified as relevant across the corpora at hand and illustrate their realizations in therapeutic and coaching discourse. First, we will look at the emotional work that therapist and coach engage in in their particular professional relationship with their clients: the therapeutic/coaching alliance. The therapeutic alliance relates to creating, maintaining and facilitating the relationship between the therapist and the client and is considered one of the essential elements that define the psychotherapist-client dyad (cf. Greenberg et al. 1993; Spinelli 1997/2006) across numerous currently practiced psychotherapeutic schools and protocols (cf. Erskine 1998; Moursund and Erskine 2004; Horvath 2005; Voutilainen 2012). As holds for the professional relationship between therapist and client, the sine qua non of a successful coaching interaction is a trustful, open and empathic relationship between coach and client (cf. O’Broin and Palmer 2010: 12; Lee 2013: 47): “The ‘product’ of coaching comes from the bond between a coach and a client” (Hudson 1999: 26).6 The second type of feelings-talk refers to various aspects of eliciting, refocusing and evoking emotions in the client. Clients’ emotions and emotionality are thereby first brought into the open, i.e. turned into the primary conversational topic, and then further processed along the ensuing interaction (Fiehler 2004) to allow for a reinterpretation and reorganization that enhances the clients’ quality of life.



6. Given the relevance of the relationship between coach and client, ‘establishing the relationship’ is defined as one of the four basic activities of coaching (cf. Graf in prep.).

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Both types of feelings-talk are very much intertwined in the ongoing talk between therapist/coach and their clients. 4.2.1 Creating the therapeutic/coaching alliance The therapeutic or coaching alliance is not a preordained entity but rather an interactional phenomenon that needs to be performed and accomplished in the actual conversation between the psychotherapist and the client (cf. Leudar et al. 2006) and coach and client, respectively. The therapist thereby communicates to the client that she/he is an involved and attuned listener who finds the client’s experience to be real and valid (cf. Greenberg and Paivio 1997: 2). The psychotherapist builds and manifests his/her emotional contact with the client by offering such qualities as warmth, involvement and empathy. In Greenberg et al.’s words (1993: 4), “this enables the person to feel safe enough to allocate maximal processing capacities to the task of exploring and generating new emotional meanings”. The therapeutic alliance then provides a fundamental basis for any other/further work to be performed in psychotherapy. Concurrently, the coaching alliance is the immediate context of the coaching interaction and as such functions as an affective frame that creates the necessary stability and security for dealing with insecurity and challenge on the thematic level (cf. Martens-Schmid 2009: 19). It creates the essential non-judgmental empathic self-space that allows for the verbalizing and constructing of less dominant discourses; talk with their coaches is often described as emancipatory and agentive by clients (cf. McLeod and Wright 2003: 6), i.e. “(h)aving a place to ‘release’ frustration or anxiety and express their deepest desires or fear, as in the coaching relationship, is very freeing” (Williams and Davis 2007: 6). As regards the particular strategies that therapist and coach apply to create the emotional alliance with their clients, ‘validation’ and the ‘therapist’s/coach’s emotional presence’ have been chosen to illustrate the respective qualities of the professional alliance.

4.2.1.1 Validation. In the first extract presented below, the strategy of validation is illustrated by an example from the therapeutic data. Here a male client addresses his relationship with his mother: Extract 1a. Validation in psychotherapy7


01 C i think she was depressed (.) 02 without any people around 03 she liked to have people around


7. See Selting et al. (2011) for transcription conventions.

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04 05 06 07 T 08 09 C 10 T 11 12 C 13 T 14 15 16 C 17 18 T 19 20 C 21→T 22 C 23→T

she felt lonely but um i also think she lived up to a good mother (.) but i always had a feeling it was fake so can she live up to being a good mother if she doesn_t have a good son no or can one only be a good mother if she has a good son yeah what comes to your mind when i say that and what kind of mother is she if she has a natural son it wasn_t that important to her it was important for her to have a good son so she has some image that she has to portray to the world where you have to play a role in that image yes no wonder you_re angry no wonder you wanna rebel yeah makes sense

In lines 1–6 the client discloses his views concerning his mother. The client’s highly intimate revelation ends with the disclosure concerning his mother’s keeping up appearances of being a good caretaker (but I always had a feeling it was fake). The therapist uses this intimate disclosure to refocus the client’s attention on himself (lines 7–8 and 10–11). Thus ‘faking’ being a good mother could only be accomplished if the client himself participated in the endeavor. This thought is explicitly stated by the therapist in lines 18–19. In line 20 the client agrees with such a scenario by producing a minimal acknowledgement token. The therapist – in line 21 – attempts to account for the client’s rebellious behavior by attributing it to his life circumstances, i.e. the warped relationship with his mother. The client, again, minimally acknowledges the therapist’s comment (line 22). The therapist normalizes the client’s anger by contextualizing it in the client’s family situation. Thus the client’s acting makes sense (line 23) when construed in the context of his life situation. By validating and normalizing the client’s experience, the therapist builds an emotional bond with the client which is essential for pursuing further emotional work aimed at reorganizing his emotional experience.


Extract 1b. Validation in executive coaching We witness a similar bonding between coach and client in the following example from the coaching data (Extract 1b). The client is recounting her medical odyssey to find the reasons for her rare autoimmune disorder: just before the session she found out that the material in her teeth fillings is badly affecting her kidneys.


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01 C 02 03 04 05 06 07 K 08 C


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(it_s enough to make you despair) (so zum verzweifeln) that means there_s really no (--) no das heißt da gibt_s tatsächlich kein (--) kein substance which which isn_t harmful material was was nicht schädlich is for the kidneys für die nieren