Power and dialogue: A review of discursive research.

Collaborative-dialogic approaches to family therapy advise therapists to take a position of client-as-expert and promote an equality of multiple perspectives. This has led to debates about how to conceptualize power in dialogical therapies with scholars theorizing and researching power as social and negotiated through interaction. We aimed to understand power in dialogical therapy through reviewing discursive research on therapeutic conversations. We performed a systematic search of bibliographical databases PsycINFO, PubMed, and CINAHL. We reviewed the findings from 18 studies utilizing discursive analyses of collaborative-dialogical therapy sessions and examined their findings in relation to power within interactions. We found a strong focus on the practices of the therapist rather than on those of the client. The therapist was presented as a catalyst of dialogue using minimal and active responses to promote dialogical conversations. Therapists also utilized power in response to broader institutional and social demands that may not be consistent with some interpretations of dialogical therapy. We consider practice implications where the exercise of power to direct a session facilitates dialogical interactions.

How is Systemic and Constructionist Therapy Change Process Narrated in Retrospective Accounts of Therapy? A Systematic Meta-synthesis Review.

Despite the considerable potential of qualitative approaches for studying the systemic and constructionist therapy process due to shared theoretical and epistemological premises, to date there is lack of a comprehensive qualitative synthesis of how change process is experienced and conceptualized by clients and therapists. To address this evidence gap, we performed a systematic meta-synthesis review of 30 studies reporting clients' and therapists' retrospective narratives of change process across systemic and constructionist models and across a range of client configurations, including individuals, couples, families, and groups. The studies were identified following a systematic search in PsycINFO and MEDLINE resulting in 2,977 articles, which were screened against eligibility criteria. Thematic analysis led to the identification of four main themes: (1) navigating through differences, (2) toward nonpathologizing construction of problems, (3) navigating through power imbalances, and (4) toward new and trusting ways of relating. Findings illustrate the multifaceted aspects of systemic and constructionist change process, the importance for their reflexive appraisal, and the need for further research contributing to the understanding of the challenges inherent in the systemic and constructionist therapeutic context.

A pesar del potencial considerable de los enfoques cualitativos para estudiar el proceso de la terapia sistémica y construccionista debido a premisas teóricas y epistemológicas compartidas, hasta la fecha hay una escasez de síntesis cualitativas completas de cómo los pacientes y los terapeutas viven y conceptualizan el proceso de cambio. Para abordar esta falta de datos, realizamos una revisión sistemática de la metasíntesis de 30 estudios que informan historias retrospectivas de los pacientes y los terapeutas del proceso de cambio entre modelos sistémicos y construccionistas y entre una variedad de configuraciones de pacientes, entre ellas, individuos, parejas, familias y grupos. Los estudios se identificaron después de una búsqueda sistemática en PsycINFO y MEDLINE, de donde se obtuvieron 2,977 artículos, que se analizaron según los criterios de elegibilidad. El análisis temático condujo a la identificación de cuatro temas principales: 1) orientarse entre las diferencias, 2) hacia una construcción no patologizante de los problemas, 3) orientarse entre los desequilibrios de poder, 4) hacia formas nuevas y confiables de relacionarse. Los resultados ilustran los aspectos multifacéticos del proceso de cambio sistémico y construccionista, la importancia para su valoración reflexiva y la necesidad de más investigaciones que contribuyan a la comprensión de los desafíos inherentes en el contexto terapéutico sistémico y construccionista.

The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta-Synthesis Review of In-Session Therapy Discourse.

Despite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in-session therapeutic dialogue. In this paper, we present a qualitative meta-synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies' findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non-pathologizing therapeutic dialogue, (c) moving-forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis.

A pesar del énfasis de los enfoques sistémicos y construccionistas sobre el discurso y la interacción, hasta ahora no se ha hecho una descripción general completa de cómo se lleva a cabo el proceso de cambio dentro del diálogo terapéutico en la sesión. En este artículo presentamos una metasíntesis cualitativa de 35 artículos que informan datos del proceso de terapia sistémica y construccionista obtenidos del diálogo terapéutico que se produce naturalmente. Los estudios se eligieron siguiendo los criterios de evaluación por elegibilidad de una muestra total de 2977 estudios detectados mediante una búsqueda sistemática en las bases de datos PsycINFO y MEDLINE. El análisis temático de los resultados de los 35 estudios identificó cuatro temas principales que describen la representación del proceso de cambio; (a) el cambio a una perspectiva relacional, (b) el cambio a un diálogo terapéutico no patologizante, (c) el diálogo de avance, y (d) la interacción dialógica del poder. Los resultados destacan la matriz interactiva y discursiva dentro de la cual se produce el proceso de cambio sistémico y construccionista. Los resultados ilustran el valor de los estudios de investigación cualitativa que muestrean el discurso terapéutico producido naturalmente a la hora de presentar esta matriz, particularmente cuando se utilizan metodologías discursivas, como el análisis de la conversación o el discurso.

Internalized Other Interviewing in Relational Therapy: Three Discursive Approaches to Understanding its Use and Outcomes.

For over 20 years, family therapist Karl Tomm has been engaging families and couples with a therapeutic intervention he calls Internalized Other Interviewing (IOI). The IOI (cf. Emmerson-Whyte, 2010; Hurley, 2006) entails interviewing clients, from the personal experiences of partners and family members as an internalized other. The IOI is based on the idea that through dialogues over time, one can internalize a sense of one's conversational partner responsiveness in reliably anticipated ways. Anyone who has thought in a conversation with a family member or partner, "Oh there s/he goes again," or anticipates next words before they leave the other's mouth, has a sense of what we are calling an internalized other. For Tomm, the internalized anticipations partners and family members may have offers entry points into new dialogues with therapeutic potential-particularly, when their actual dialogues get stuck in dispreferred patterns.

Diagnoses, Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM-5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths-based orientations, many tensions can follow when use of the DSM-5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM-5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.

Colaboração, generatividade, rigor e imaginação: quatro palavras para focar e estimular nossas investigações orientadas pela prática / Collaboration, generativity, rigor & imagination: four words to focus and animate our practice-oriented inquires

Este trabalho apresenta a visão de que clientes, terapeutas e pesquisadores orientados à prática podem compartilhar um interesse comum ao se voltar às inquietações humanas como formas de investigação. Esta orientação de pesquisa ativa voltada às preocupações humanas deriva, em parte, da abordagem de Andersen aos problemas pessoais e de relacionamento enquanto nascidos de “diálogos paralisado”. Portanto, o papel do terapeuta e pesquisador orientado pela prática é, alternativamente, engajar seus clientes em novas formas de investigação dialógica. Quatro palavras são oferecidas para guiar conceitualmente como tais investigações dialógicas podem ser otimizadas de forma a estimular clientes, terapeutas e pesquisadores.(AU)

This paper presents the view that clients, therapists, and practice-oriented researchers can share a common interest in addressing human concerns as arrested forms of inquiry. This action research orientation to human concerns derives in part from Andersen’s approach to personal and relational problems as arising within “stalled dialogues”. Thus, the role of therapist and practice-oriented researcher from this orientation is to alternatively engage clients in new forms of dialogic inquiry. Four words are offered to conceptually guide how such dialogic inquiries can be optimized in ways that animate clients, therapists, and researchers.(AU)

Doing recovery online.

Although problem gambling is becoming more prevalent, research shows that many problem gamblers do not seek help. Online social support forums have become an increasingly popular option for receiving support for problem gambling. Few researchers have explored how participants within these forums interact, or what is supportive about participation in online communities. Melding netnography (ethnographic approaches online), discourse analysis, and ethnomethodology, we analyzed the discursive interactions of self-identified problem gamblers on an online forum. We report on the characteristics of this unique setting, the common discourses that members used, and how they discursively accomplished various interactional tasks, including constructing identities, and negotiating membership, legitimacy, and support. We conclude with recommendations for practitioners and researchers interested in better understanding people trying to overcome problem gambling and other behavioral concerns.

Sobre o DSM-V* / About the DSM-V

O Manual diagnóstico e estatístico dosTranstornos Mentais (Diagnostic and Statistical Manual of Mental Disorders; quinta edição; DSM-V) está a ponto de ser publicado, embora tenha havido consideráveis controvérsias em sua gestação. Neste artigo faço uma revisão histórica crítica sobre os desenvolvimentos associados ao DSM-V, especialmente os desenvolvimentos relacionados às práticas de narrativa ou outras levadas a cabo por profissionais construcionistas. Relato os descobrimentos de uma pesquisa recém-completada na qual profissionais revelaram como respondem à influência do atual DSM-IV-TR em suas conversas com clientes, bem como as formas como responderam criativamente à tal influência. Fecho com sugestões para profissionais que trabalham junto a administrações que pedem o uso dos diagnósticos DSM-V em seu trabalho conversacional.(AU)

The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-V) is nearing publication, despite considerable controversies over its development. In this paper I provide a critical historical review of developments associated with the DSM-V, particularly as these developments relate to the practices of narrative and other constructionist practitioners. I relate the findings of recently completed research in which practitioners shared how they responded to the influence of the current DSM-IV-TR on their conversations with clients, along with ways they creatively responded to that influence. I close with suggestions for practitioners Who live with administrative expectations that they use DSM-V diagnoses in their conversational work.(AU)

Negotiating exceptions to clients' problem discourse in consultative dialogue.

OBJECTIVE: The purpose of this qualitative study was to examine how consultants negotiated exceptions to clients problem or aspiration discourse in lifestyle consultations held for research purposes. DESIGN: Participants from a university campus (students and employees) were recruited for 1-hr lifestyle consultations with therapist consultants having graduate training and supervision in narrative and solution-focused therapy. The consultations were held with the expectation that consultants would, at least once, invite discussions of exceptions in client's problem or aspiration discourse. We wanted to understand how such discussions were initiated and brought to conclusion by examining client and consultants use of conversational practices. METHOD: Twelve volunteer 'clients' participated in consultations with our six volunteering consultants. These consultations were videotaped then passages were selected where consultants initiated exception discussions with the clients involved. The 18 selected passages were discursively analyzed for general rhetorical features evident in those passages, and three passages were transcribed and analyzed using conversation analysis to make evident more specific rhetorical features of exception discussions, as they were engaged in by consultants and clients. RESULTS: Ten general features of exception discussions were highlighted and the more specific conversational analyses revealed a 'messiness' that was related to how exception discussions were introduced and negotiated as a novel discourse in the consultations. CONCLUSIONS: We discuss our findings in the context of therapists' use of exception questions and discussions in therapy and highlight particular conversational practices and sensitivities relevant to engaging clients in such exception discussions.

Clients as conversational agents.

OBJECTIVE: Conversational agency is our invented term that orients us to ways in which clients participate in therapeutic dialogues. In this study we examined how clients' conversational correctives and initiatives influenced collaborative therapeutic consultations. METHODS: Thirty-five single-session lifestyle consultations were videotaped in which adult clients volunteered to discuss concerns of non-clinical severity with a counselor. We discursively microanalyzed excerpts where clients initiated topic shifts or corrected counselor misunderstandings and how counselors responded to them. RESULTS: Clients were actively involved in co-managing conversational developments during the consultations. They influenced the content and course of the conversations with the counselors by correcting, interrupting, or speaking from positions contrary or unrelated to those of the counselors. CONCLUSION: Clients observably influenced the conversational agenda through their correctives and initiatives if counselors were responsive during face-to-face consultations. PRACTICE IMPLICATIONS: Clinicians should demonstrate increased sensitivity and relational responsivity by intentionally engaging with clients' agentive contributions to consultative dialogues.

Conversational evidence in therapeutic dialogue.

Family therapists' participation in therapeutic dialogue with clients is typically informed by evidence of how such dialogue is developing. In this article, we propose that conversational evidence, the kind that can be empirically analyzed using discourse analyses, be considered a contribution to widening psychotherapy's evidence base. After some preliminaries about what we mean by conversational evidence, we provide a genealogy of evaluative practice in psychotherapy, and examine qualitative evaluation methods for their theoretical compatibilities with social constructionist approaches to family therapy. We then move on to examine the notion of accomplishment in therapeutic dialogue given how such accomplishments can be evaluated using conversation analysis. We conclude by considering a number of research and pedagogical implications we associate with conversational evidence.

Reflections on reflecting as a dialogic accomplishment in counseling.

In this exploratory study, the author examines reflection as a dialogic phenomenon constructed in the back-and-forth of counseling dialogue. He videotaped and microanalyzed 11 one-hour lifestyle consultations for the conversational practices used by counselors and clients in collaboratively reflecting on developments in their dialogues. He then invited counselors and clients back to comment on their participation in videotaped passages of their dialogue selected for microanalysis, thus permitting a juxtaposition of their retrospective comments with the analysis. The author considers the results from this study with respect to training counselors and for pointing new ways to widen the evidence base with respect to interventions in counseling, particularly social constructionist approaches.