Managing Distress Over Time in Psychotherapy: Guiding the Client in and Through Intense Emotional Work

Abstract

Clients who seek psychotherapeutic treatment have had personal experiences involving some form of distress. Although research has shown that the client's ability to experience and express painful emotions during therapy can have a therapeutic benefit, it has also been argued that displaying distress may convey a form of helplessness and vulnerability, and thus, clients may be reluctant to cast themselves in this light. Using the methods of conversation analysis, this paper explores how a client's upsetting experience is managed over the course of a single session of client-centered therapy. The main analytic focus will be on (1) the different therapist practices used to orient to the client's distress, (2) the varying forms of client opposition to the therapist's attempts to work with the distress, and (3) the context sensitivity of orienting to distress and how certain practices may be uniquely shaped by what had occurred in prior talk. It was found that, whereas certain types of therapist responses tended to be endorsed by the client, others were forcefully rejected as inappropriate displays of understanding or empathy. By focusing on repeated sequential episodes over time in which a client conveys distress, followed by the therapist's response, this paper sheds light on the interactional trajectory through which a client and therapist are able to resolve impasses to emotional exploration and to successfully secure extended and intense emotional work.

Receiving teletherapy in Ireland: The experiences of service users in the public mental health system

“…It appears that their impact was most profoundly felt when difficulties occurred during moments of intense emotional processing, resulting in a lost understanding on the part of the therapist due to the drop in the audio/visual connection and the need for participants to repeat distressing or personal disclosures, something which was often a source of frustration and discomfort. These tech‐related interruptions may also have more far‐reaching implications; as Muntigl (2020) noted, therapists' failures to affiliate appropriately with clients' distress during such intense moments can bring tension and discord into the therapeutic relationship. Whilst participants in the present study did not explicitly describe such effects, those common feelings of “frustration” in the face of having to repeat oneself, or being misunderstood, are likely to impinge on feelings surrounding the relationship in general.…”

Doing-together with words: the sequential unfolding of a moment of meeting in a psychoanalytic therapy session

“…Whilst CA commonly draws on collections of multiple instances of an interaction phenomenon, previous research has used analysis of single episodes of interaction to apply prior knowledge on the organization of a domain of talk-in-interaction to illuminate a specific segment of talk ( Schegloff, 1987 ; Whalen et al, 1988 ). In CA studies of psychotherapy, for instance, a single-case analysis has been used to illustrate how client and therapist manage impasses to emotional exploration, mapping the clinically relevant trajectory through which they can successfully secure extended and intense emotional work ( Muntigl, 2020 ).…”

“…Regarding (1), he proposes a general model of sequential organization of psychotherapy interaction as a useful heuristic for researchers to identify sequential relations in their data. It consists of a Prior Action (PA); an initiating Target Action (TA), which is the focus of the analysis; a responding action or Response (RE); and a Third Position Action (TP) closing the exchange ( Peräkylä, 2019 ; Muntigl, 2020 ). Regarding (2), Peräkylä points out that transformation of experience plays a crucial role in psychotherapy process; drawing on the CA principle of nextness ( Schegloff, 2007 ), he proposes that such a sequence of adjacent conversational turns can be considered a vehicle for transformation of experience: “‘Nextness”’ of any turn at talk makes it inevitable that the current speaker will orient him/herself to the experience embodied in the prior turn.” ( Peräkylä, 2019 , p. 266).…”

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

“…Traditionally, the therapeutic relationship has been studied in great detail via questionnaires and checklists that are suitable to quantitative statistical analyses. While this methodology offers many advantages, including reproducibility, comparability and the attribution of exact impact scores to specific parts of the therapeutic process (Norcross and Lambert, 2018a), it has been pointed out (e.g., Muntigl and Horvath, 2014;Norcross and Lambert, 2018b;Muntigl, 2020;Storck et al, 2020) that it is difficult to address a number of relevant questions in this manner. First, questionnaires or checklists do not document the therapeutic relationship itself, but only what the participants are willing and able to (consciously) disclose about the interactive processes between them.…”