First Encounters in Psychotherapy: Relationship-Building and the Pursuit of Institutional Goals

Abstract

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time.

Sprechen und Schweigen in der Psychotherapie

“…1, S. 209). Die Unverzichtbarkeit kultureller Reserven für die Deutung in der Sitzung wurde durch KA-Studien belegt (Scarvaglieri 2020). Deutungen stellen Zusammenhänge zwischen Erfahrungsbereichen her (Peräkylä 2004, S. 293).…”

Helfen im Gespräch

“…Auch die Dauer der Gesprächsprozesse und die Intensität des Kontakts zwischen den Beteiligten unterscheidet sich stark. Während die Psychotherapie eine langanhaltende Beziehung, die über Jahre andauern kann, auf baut (Scarvaglieri, 2020), sind die Kontakte in der Rechtsberatung eher wenige und nehmen im Lauf der Zeit in ihrer Intensität eher ab, auch wenn sich rechtliche Verfahren ebenfalls über Jahre hinziehen können. Diese Unterschiede machen die Frage bedeutsam, weshalb sie trotzdem alltagssprachlich und heuristisch unter dem Begriff des Helfens zusammengefasst werden.…”