Exploring Conversational and Physiological Aspects of Psychotherapy Talk

Abstract

This study is part of a larger exploration of 'talk and cure' that combines the examination of talk-in-interaction with nonverbal displays and measurements of the client's and therapist's autonomic arousal during therapy sessions. A key assumption of the study is that psychotherapy entails processes of intersubjective meaning-making that occur across different modalities and take place in both verbal/explicit and nonverbal/implicit domains. A single session of a psychodynamic psychotherapy is analyzed with a focus on the expression and management of affect, with an aim to describe key interactive events that promote change in both semantic and procedural domains. The clinical dialog is analyzed discursively, with a focus on the conversational processes through which new meanings are jointly constructed and affective states shared; detailed attention is paid to nonverbal displays of affiliation and affect. Furthermore, we explore whether the interactional patterns implicated in joint meaning-making, as revealed by analyzing the therapeutic conversation, have correlates in the autonomic arousal of the two protagonists, as reflected in their heart rates. Conversation analysis has still untapped potential to illuminate interactional patterns that underlie the practice of psychotherapy. In this exploratory study we suggest that discursive analyses of talkin-interaction can be enriched through detailed focus on nonverbal displays as well as measures of physiological arousal. Drawing upon the analysis, we suggest that bringing the methodological strengths of language-based analysis into fertile dialog with embodied quantitative data can help our explorations of what's really going on in psychotherapy.

Studying Physiological Synchrony in Couple Therapy through Partial Directed Coherence: Associations with the Therapeutic Alliance and Meaning Construction

“…This is in line with the recognition that psychological and social processes cannot be isolated from embodiment and affect [21,22]. The inclusion of affective and embodied aspects of interaction is arguably particularly relevant to psychotherapy, given that affect is intimately linked with meaning construction and forms an integral part of the work of therapy [23]. The Autonomic Nervous System (ANS) plays a key role in cognition, emotion and behavior [24], and although ANS activation is not specific to affect, most emotions are associated with increased physiological arousal [25,26].…”

“…The findings of this study point to the complex interplay between explicit and implicit levels of interaction and the potential added value of including physiological synchrony in the study of interactional processes in couple therapy [36,55,72,85,86]. In line with contemporary theories of therapeutic change, a key assumption of this work is that psychotherapy entails processes of intersubjective meaning making that take place through different modalities and, presumably, with different degrees of conscious awareness [23]. From this perspective, including measures of physiological activation in the study of psychotherapy sessions can help examine implicit, embodied interactional processes that contribute significantly to the formation of the therapeutic alliance, the co-creation of new meanings and, ultimately, therapeutic change.…”

“…In this literature, it is assumed that measures of psychophysiology enable the study of aspects of the therapy process that may not be accessible through self-report or observation, and can therefore add another layer of information on clinical process [29]. In other words, psychophysiological measures may reflect non-conscious, implicit affective processes and can then be used as correlates of implicit intra-and interpersonal processes in therapy [23,30]. In addition to these theoretical developments, technological advances make the continuous recording of physiological states in therapy relatively easy and unobtrusive.…”

“…In the context of psychotherapy, physiological synchrony between therapists and clients was first examined in a series of studies in the 1950s in relation to rapport and empathy [35]. More recently, the role of IPS in the psychotherapy process has been examined in several studies of psychotherapy sessions [3,23,30,[36][37][38][39][40], as well as simulated sessions [13,38,41]. In a recent review of this literature, Kleinbub [14] concluded that physiological synchrony in psychotherapy is an established fact, although its clinical meaning is far from known.…”

“…Recent reviews suggest that, given how little we know about the context-specific factors that affect IPS, it may be preferable to use idiographic designs and theoretically informed analyses of the therapy process. Since the publication of these reviews, a few such studies have been published that shed light on the different functions of physiological synchrony in psychotherapy [23,30,37,42,[55][56][57].…”