Intersubjectivity in therapeutic interaction: a pragmatic analysis

Abstract

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.

How to do things with questions: the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with depressed adolescents

“…Ruptures and repairs are recognised as universal features of conversational interactions and are identified at the level of the turn (Sacks, 1992;Schegloff, 1992Schegloff, , 2006. According to Knox and Lepper (2014), ruptures in a conversation occur when there is a clash in participants' perspectives. When a rupture occurs, the participants often work to restore the turn-taking order to enable the conversation to continue.…”

“…Although there is no CA research that aims specifically to focus on the use of patients' questions in psychoanalytic psychotherapy, some studies reveal patients' questions in their transcriptions. For example, in a single case study, Knox and Lepper (2014) show how an adult patient's question subverted a therapist's intended direction and controlled the conversational agenda.…”

The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails

“…Knox and Lepper () have drawn on such research to argue that it is these fundamental ‘rules’ of interpersonal communicative and relational interaction that we intuitively find so rewarding and that it is therefore the activation of these processes that has positive therapeutic effects, rather than any higher level theories about the human mind that we may draw on. These are the building blocks of the therapeutic alliance, the tools that both therapist and patient draw on to co‐construct a shared set of meanings, coordinating the timing of their respective contributions and repairing ruptures between them in the dynamic process of turn‐taking.…”

“…A number of authors have emphasized that this process is not just the sum of two individual perspectives because these meaning‐making interactions take on an autonomy of their own, influencing and transforming each participant (De Jaegher & Di Paolo, ; Fuchs & de Jaegher, ; Knox & Lepper, ). Ogden () and Benjamin () describe this as the analytic third in which the individual subjectivities of analyst and analysand are initially subjugated to a co‐created third subject of analysis through projective identification.…”