There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.

In this paper we describe and analyze the development of a psychotherapist's reformulations of one client's initial agentless problem narration. The concept 'agentless' refers to the use of impersonal constructions-passive voice, nominalizations, zero-person construction, and iterative verbswhich all imply having no control over the described actions. 'Agentless talk' is viewed in this paper as a strategy to escape full personal responsibility and thus as a strategy to save one's moral face (Brown andLevinson 1978, 1987;Go¤man 1955). In this case, the therapist approached the dilemma between protecting the client's face and fulfilling the institutional goal of helping the client by varying the footing in his reformulations of problem descriptions. Delicateness in the therapist's reformulations, as found in the data, can thus be seen as more than conversational etiquette; it is a necessary therapeutic tool. To account for the changes taking place in the therapeutic process, no reference to models of inner psychological structures or organization was needed, which poses a question of the quality of 'therapeutic change'.

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ, when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called ‘relational autonomy’.

No abstract

+358504432361 AcknowledgementsWe thank Petri Kinnunen and Lauri Viljanto for assisting in technical issues related to the study design. Author ContributionsVLK: designed and executed the study, analyzed the data (SRI, measures, integration of the modalities), and wrote the paper. AT: designed and executed the study, analyzed the data (psychophysiological measures), and collaborated in writing of the paper. PNS: analyzed the data (bodily mirroring) and collaborated in writing of the paper. KK: analyzed the data (conversational exchange), and collaborated in writing of the paper. JW: analyzed the data (conversational exchange), and collaborated in writing of the paper. JK: designed the study and collaborated in writing of the final manuscript. MP: designed the study and collaborated in writing of the final manuscript. JS: designed the study and collaborated in writing of the final manuscript.