Diagnostic formulations in psychotherapy

Abstract

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances.But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations (both of the gist of the client's words and of their implications) that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's history and symptoms. In doing so, these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe.

Notionalization: The Transformation of Descriptions into Categorizations

“…A robust finding about formulations, which is confirmed by several studies, is that they are used by institutional agents to selectively focus on and retain those aspects of first versions of laypersons which are judged to be relevant for further talk according to the institutional agenda (Heritage and Watson 1979;Antaki et al 2005;Hutchby 2005;Barnes 2007). Drew (2003) shows by comparison of formulations in four institutional settings how they are tailored to specific institutional tasks in terms of their linguistic design, the selection of contents which are formulated and the local functions in their sequential context.…”

“…2 Also is not exclusively used for notionalizations, but it is a routine device for prefacing formulations in German, and it is by far the most common item to be used for indexing a notionalization. Its discursive function and its semantics as a preface to formulations are identical to English so in this position (see Antaki et al 2005;Drew 2003;Heritage and Watson 1979;Hutchby 2005). 3 Still, there is an important syntactic difference between German and English: In contrast to English so, also can be used in non-sentential formats as well, i.e., introducing a TCU with only phrasal syntax (e.g., also ?…”

“…As is typical of formulations (see Antaki et al 2005), notionalizations are often used for topical closure by providing a categorical conclusion which is to subsume and put an end to the seesaw of negotiations (#8 being an example). In this way, categorizations are used as means of transforming descriptions according to (sometimes one-sided, strategic) practical relevancies and for reducing conceptual and controversial complexity in the service of interactional progression (Bilmes 1981;Deppermann and Spranz-Fogasy 1998).…”

“…As is typical of formulations in psychotherapy, this formulation is geared to a therapeutic end (cf. Antaki et al 2005;Antaki 2008;Rae 2008), in this case, to encourage the patient to grapple with the new tasks waiting for him in the near future.…”

“…Prior research has gained insight into the ways how institutional agents use formulations for institutional concerns, e.g., in psychotherapy (Antaki et al 2005;Antaki 2008), child counselling (Hutchby 2005), news interviews (Heritage 1985), and meetings (Barnes 2007). While sequential and functional properties of formulations and the ways in which they are adapted to institutional settings have been explored in considerable depths, the semantic and turn-constructional aspects of formulations did not figure as prominently in prior research (Deppermann 2011, this volume).…”