Twelve transcripts, three from each of four patients, taken from the early, mid and late phases of open‐ended, long‐term psychoanalytic psychotherapy with the same therapist, were analysed for metaphor. Metaphors were categorized into key, novel and conventional. Using grounded theory metaphors were categorized by theme and function. It was found that all metaphors – novel, conventional and key – could be representative of key concepts such as the self, others/relationships and therapy/self transformation and diagnosis or psychopathology; chart change; indicate mentalization (Fonagy et al. 2004). In addition use of metaphors by different patients showed different patterns that co‐occurred with good or bad outcome.
The research reported in this article aims to demonstrate a method for the systematic study of the therapist/patient interaction in psychoanalytic psychotherapy, drawing upon the tradition and methods of 'pragmatics'--the study of language in interaction. A brief introduction to the discipline of pragmatics demonstrates its relevance to the contemporary focus of clinical theory on the here-and-now dynamics of the relationship between analyst and patient. This is followed by a detailed study of five segments from the transcript of a therapeutic dialogue, drawn from a brief psychoanalytic psychotherapy, in which therapist and patient negotiate the meaning of the patient's symptom: Is it psychosomatic? The research seeks to show how the therapeutic process can be observed and studied as an interactional achievement, grounded in general and well-studied procedures through which meaning is intersubjectively developed and shared. Implications of the analysis for clinical theory and practice, and further research, are discussed.
This is the third of a series of pilot studies that seeks to validate a method for the identification and analysis of clinically significant interactions in the psychotherapy process. Using a combined method, the authors demonstrate that the therapeutic cycles model (Mergenthaler, 1996) can be used reliably to identify clinically significant events across sessions, which can then be analyzed at the level of the therapist-client interaction using conversation analysis, a discipline that has generated a substantial body of knowledge of how meaningful interaction is achieved by speakers on a turn-by-turn basis. The authors demonstrate that significant events can be compared within and across cases in order to understand how therapist interventions contribute to within-session micro-outcomes and, ultimately, to outcomes across populations of cases.
This study draws on recent observational research on the intersubjective processes that occur in infant -caregiver interactions. It makes the case that similar methods can be used to develop an observational approach to the dynamics of intersubjectivity in the clinical process using methods from the discipline of pragmatics -the study of human interaction. Following an introduction to the research on intersubjective processes in infant-caregiver dyads and a discussion of the pragmatic approach to the study of talk-ininteraction, we present a detailed analysis of an exchange between a psychotherapist and a patient. Rupture and repair, narrative processes and perspective-taking are observed at the level of the turn-by-turn interactions between the participants. The discussion returns to clinical concerns, discussing the implications of the findings for the study of clinical theory and practice.
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